title: Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer.
abstract: BACKGROUND
  Long-term data from the CLASICC study demonstrated the oncologic equivalence of laparoscopic and open rectal cancer surgery despite an increased circumferential resection margin involvement in the laparoscopic group in the initial report. Moreover, laparoscopic total mesorectal excision (TME) may be associated with increased rates of male sexual dysfunction compared to conventional open TME. Robotic surgery could potentially obtain better results than laparoscopy. The aim of this study was to compare the clinical and functional outcomes of robotic and laparoscopic surgery in a single-center experience.
  
  
  METHODS
  This study was based on 100 patients who underwent minimally invasive anterior rectal resection with TME. Fifty consecutive robotic rectal anterior resections with TME (R-TME) were compared to the first 50 consecutive laparoscopic rectal resections with TME (L-TME).
  
  
  RESULTS
  Median operative time was 270 min in R-TME and 275 min in L-TME. No conversions occurred in the R-TME group whereas six conversions occurred in the L-TME group. The mean number of harvested lymph nodes was 16.5 ± 7.1 for R-TME and 13.8 ± 6.7 for L-TME. The circumferential margin (CRM) was <2 mm in six L-TME patients, whereas no one in R-TME group had a CRM <2 mm. The International Prostate Symptom Score (IPSS) scores were significantly increased 1 month after surgery in both the L-TME and R-TME groups, but they normalized 1 year after surgery. Erectile function worsened significantly 1 month after surgery in both the groups but it was restored completely 1 year after surgery in the R-TME group and partially in the L-TME group.
  
  
  CONCLUSIONS
  Robotic TME is oncologically safe and adequate for rectal cancer treatment, showing better results than laparoscopic TME in terms of CRM, conversions, and hospital length of stay. Better recovery in voiding and sexual function is achieved with the robotic technique.
authors.affiliation: Minimally Invasive and Robotic Surgery Unit, San Giovanni Addolorata Hospital, Via dell'Amba Aradam 9, Rome, Italy.
authors.forename: Annibale
authors.initials: A
authors.lastname: D'Annibale
authors.forename: Graziano
authors.initials: G
authors.lastname: Pernazza
authors.forename: Igor
authors.initials: I
authors.lastname: Monsellato
authors.forename: Vito
authors.initials: V
authors.lastname: Pende
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lucandri
authors.forename: Paolo
authors.initials: P
authors.lastname: Mazzocchi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Alfano
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D007172:Erectile Dysfunction / Q000209:etiology; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012141:Respiratory Tract Infections / Q000209:etiology; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome