title: Open, laparoscopic, and robotic surgery for rectal cancer: medium-term comparative outcomes from a multicenter study.
abstract: OBJECTIVE
  Several studies have demonstrated the oncologic equivalence of laparoscopic (LS) and open (OS) rectal cancer surgeries and have shown how challenging LS may become. Robotic surgery (RS) has emerged as a practical alternative, offering interesting advantages in comparison to both LS and OS. The aim of this study is to resolve the clinicopathologic outcome advantages of RS with respect to OS and LS techniques.
  
  
  METHODS
  Patients with rectal cancer undergoing OS, RS, or LS were evaluated within the period from April 2009 to August 2011. The evaluations were carried out in 4 Italian hospitals. Perioperative clinicopathologic data, postoperative complications, and 3-year overall and disease-free survival (DFS) rates were analyzed.
  
  
  RESULTS
  A total of 160 patients (94 male, 66 female) were included. A total of 105 patients underwent mini-invasive procedure (40 LS; 65 RS), whereas OS was performed in 55 patients. Anterior resection of rectal cancer was the most performed surgical procedure (139; 87%). Median operation time was significantly longer in the RS group (p&lt;0.01). Regarding complication rates and quality of the surgical specimen evaluation, no statistical difference was found among the 3 groups. The shortest hospital stay (p&lt;0.01) was obtained from the LS and RS groups. The median follow-up was 33 months without any significant difference in overall and DFS rates.
  
  
  CONCLUSIONS
  Although RS for rectal cancer requires more time to be performed than LS and OS techniques, the analysis shows comparatively the feasibility and safety of RS in terms of perioperative clinicopathologic and medium-term outcomes.
authors.affiliation: Division of Digestive Surgery, European Institute of Oncology, Milan - Italy.|General Surgery Residency, School of Medicine, University of Milan, Milan - Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Corbellini
authors.affiliation: Division of Digestive Surgery, European Institute of Oncology, Milan - Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Biffi
authors.affiliation: Division of Digestive Surgery, European Institute of Oncology, Milan - Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Luca
authors.affiliation: Division of Digestive Surgery, European Institute of Oncology, Milan - Italy.|General Surgery Residency, School of Medicine, University of Milan, Milan - Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Chiappa
authors.affiliation: General and Emergency Surgery Department, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Costa
authors.affiliation: Hepatobilary and Pancreatic Surgery Division, European Institute of Oncology, Milan - Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bertani
authors.affiliation: General and Digestive Surgery Department, Humanitas Cancer Centre Rozzano, Milan - Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bona
authors.affiliation: Division of General Surgery, Ospedale Girolamo Fracastoro, San Bonifacio, Verona - Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Lombardi
authors.affiliation: Division of Endoscopy, European Institute of Oncology, Milan - Italy.
authors.forename: Darina
authors.initials: D
authors.lastname: Tamayo
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan - Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Botteri
authors.affiliation: General Surgery Residency, School of Medicine, University of Milan, Milan - Italy.|Palliative Care Department, European Institute of Oncology, Milan - Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Andreoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D016896:Treatment Outcome