title: Robotic versus open total mesorectal excision for rectal cancer: comparative study of short and long-term outcomes.
abstract: BACKGROUND
  Despite the several series in which the short-term outcomes of robotic-assisted surgery were investigated, data concerning the long-term outcomes are still scarce.
  
  
  METHODS
  The prospectively collected records of 65 consecutive patients with extraperitoneal rectal cancer who underwent robotic total mesorectal excision (RTME) were compared with those of 109 consecutive patients treated with open surgery (OTME). Patient characteristics, pathological findings, local and systemic recurrence rates and 5-year survival rates were compared.
  
  
  RESULTS
  There were no statistically significant differences in postoperative complications, reoperation and 30-day mortality. There were significant differences comparing groups: number of lymph nodes harvested (RTME: 20.1 vs. OTME: 14.1, P < 0.001), estimated blood loss (RTME: 0 vs. OTME: 150 ml, P = 0.003), operation time (RTME: 299.0 vs. OTME: 207.5 min, P < 0.001) and length of postoperative stay (RTME: 6 vs. OTME: 9 days, P < 0.001). The rate of circumferential resection margin involvement and distal resection margin were not statistically different between groups. There were no statistically significant differences at the 5-year follow-up: overall survival, disease-free survival and cancer-specific survival. The cumulative local recurrence rate was statistically lower in the robotic group (RTME: 3.4% vs. OTME: 16.1%, P = 0.024).
  
  
  CONCLUSIONS
  RTME showed a significant reduction in local recurrence rate and a higher, although not statistically significant, long-term cancer-specific survival with respect to OTME. Prospective randomized studies are needed to confirm or deny significantly better local control rates with robotic surgery.
authors.affiliation: Division of Colorectal Surgery, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Ramiro Barcelos Street 2350, 90035-903 Porto Alegre, Brazil. Electronic address: tlghezzi@terra.com.br.
authors.forename: T L
authors.initials: TL
authors.lastname: Ghezzi
authors.affiliation: Unit of Integrated Abdominal Surgery, Division of Abdominopelvic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: fabrizio.luca@ieo.it.
authors.forename: F
authors.initials: F
authors.lastname: Luca
authors.affiliation: Unit of Integrated Abdominal Surgery, Division of Abdominopelvic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Valvo
authors.affiliation: Department of Surgery and General Surgery Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: O C
authors.initials: OC
authors.lastname: Corleta
authors.affiliation: Division of Abdominopelvic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Zuccaro
authors.affiliation: Division of Abdominopelvic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cenciarelli
authors.affiliation: Division of Abdominopelvic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Biffi
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery* / Q000628:therapy; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy; D012007:Rectum / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome
keywords: Colorectal surgery; Comparative study; Long term outcomes; Low anterior resection; Minimally invasive surgical procedures; Rectal cancer; Robotic surgery; Total mesorectal excision