Comparison of Complications and Long-term Permanent Stoma Rate in Robot-Assisted versus Laparoscopic Low Anterior Resection: A Propensity Score Matched Retrospective Cohort Study

Abstract

Aims While some research points to the short-term advantages of robot-assisted low anterior resection (LAR) for mid-to-low rectal cancer, a detailed focus on outcomes like permanent stoma remains scant. Methods We conducted a retrospective analysis on a continuous series of non-metastatic mid-to-low rectal cancer patients. Between 2016 and 2020, these patients underwent either robot-assisted or traditional laparoscopic LAR at a singular center. We used a propensity score matching technique, and the participants were matched in a 1:2 ratio. Results Post-matching, our cohort consisted of 44 patients from the robot-assisted LAR group and 88 from the laparoscopic LAR group. The long-term results, such as overall survival, cancer-free survival, and local and distant recurrence rates, exhibited no significant differences between the two groups. However, the robot-assisted group exhibited a notably shorter average post-surgery hospitalization (10.8 vs. 16.7 days, p = 0.001), reduced incidence of anastomotic leakage (11.4% vs. 37.5%, p < 0.001), fewer patients requiring a permanent stoma (13.6% vs. 29.5% p = 0.044), and significantly lower occurrences of grade III Clavien Dindo Surgical Complications. The utilization of 3D laparoscopy was unanimous in the robot-assisted group (100% use) compared to just 40.9% in the laparoscopic group. Furthermore, the robot-assisted procedures had a diminished frequency of firing three or more staplers (2.3% vs. 26.1%, p = 0.001). A multivariate logistic regression indicated that robot-assisted LAR is independently associated with a reduced risk of permanent stoma (OR: 0.28, p = 0.033, 95% CI 0.087–0.901). Conclusion In patients with mid-to-low rectal cancer, robot-assisted LAR, despite comparable long-term survival and recurrence rates, displayed reduced complications, including fewer instances of anastomotic leakage and permanent stoma requirements than its laparoscopic counterpart. These findings imply the potential superiority of robot-assisted surgical techniques for mid-to-low rectal patients.