title: Total mesorectal excision for mid and low rectal cancer: Laparoscopic vs robotic surgery.
abstract: OBJECTIVE
  To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer.
  
  
  METHODS
  This is a retrospective study on a prospectively collected database containing 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent between January 2008 and December 2014 (robot, n = 53; laparoscopy, n = 58). The patients all had a diagnosis of middle and low rectal adenocarcinoma with stage I-III disease. The median follow-up period was 37.4 mo. Perioperative results, morbidity a pathological data were evaluated and compared. The 3-year overall survival and disease-free survival rates were calculated and compared.
  
  
  RESULTS
  Patients were comparable in terms of preoperative and demographic parameters. The median surgery time was 192 min for laparoscopic TME (L-TME) and 342 min for robotic TME (R-TME) (P < 0.001). There were no differences found in the rates of conversion to open surgery and morbidity. The patients who underwent laparoscopic surgery stayed in the hospital two days longer than the robotic group patients (8 d for L-TME and 6 d for R-TME, P < 0.001). The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group (18 for R-TME, 11 for L-TME, P < 0.001) and a shorter distal resection margin for laparoscopic patients (1.5 cm for L-TME, 2.5 cm for R-TME, P < 0.001). The three-year overall survival and disease-free survival rates were similar between groups.
  
  
  CONCLUSIONS
  Both L-TME and R-TME achieved acceptable clinical and oncologic outcomes. The robotic technique showed some advantages in rectal surgery that should be validated by further studies.
authors.affiliation: Francesco Feroci, Andrea Vannucchi, Stefano Cantafio, Alessia Garzi, Marco Scatizzi, Department of General and Oncological Surgery, Santo Stefano Hospital, 59100 Prato, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Feroci
authors.affiliation: Francesco Feroci, Andrea Vannucchi, Stefano Cantafio, Alessia Garzi, Marco Scatizzi, Department of General and Oncological Surgery, Santo Stefano Hospital, 59100 Prato, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vannucchi
authors.affiliation: Francesco Feroci, Andrea Vannucchi, Stefano Cantafio, Alessia Garzi, Marco Scatizzi, Department of General and Oncological Surgery, Santo Stefano Hospital, 59100 Prato, Italy.
authors.forename: Paolo Pietro
authors.initials: PP
authors.lastname: Bianchi
authors.affiliation: Francesco Feroci, Andrea Vannucchi, Stefano Cantafio, Alessia Garzi, Marco Scatizzi, Department of General and Oncological Surgery, Santo Stefano Hospital, 59100 Prato, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cantafio
authors.affiliation: Francesco Feroci, Andrea Vannucchi, Stefano Cantafio, Alessia Garzi, Marco Scatizzi, Department of General and Oncological Surgery, Santo Stefano Hospital, 59100 Prato, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Garzi
authors.affiliation: Francesco Feroci, Andrea Vannucchi, Stefano Cantafio, Alessia Garzi, Marco Scatizzi, Department of General and Oncological Surgery, Santo Stefano Hospital, 59100 Prato, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Formisano
authors.affiliation: Francesco Feroci, Andrea Vannucchi, Stefano Cantafio, Alessia Garzi, Marco Scatizzi, Department of General and Oncological Surgery, Santo Stefano Hospital, 59100 Prato, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scatizzi
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061887:Conversion to Open Surgery; D016208:Databases, Factual; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: Laparoscopic surgery; Minimally invasive surgery; Rectal cancer; Robotic surgery; Total mesorectal excision