Robotic-assisted low anterior resection for rectal cancer shows similar clinical efficacy to laparoscopic surgery: A propensity score matched study

doi:10.4240/wjgs.v16.i6.1558

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Surg. Jun 27, 2024; 16(6): 1558-1570
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1558

Table 1 Baseline characteristics, n (%)

Item	Before matching		P value	After matching		P value
Item	RALAR, n = 125	LALAR, n = 279	P value	RALAR, n = 111	LALAR, n = 111	P value
Gender			0.871			0.896¹
Male	76 (60.8)	172 (61.6)		67 (60.4)	65 (58.6)
Female	49 (39.2)	107 (38.4)		44 (39.6)	46 (41.4)
Age (yr)	62 (55-68)	63 (54-68)	0.957	62 (55-66)	61 (53-68)	0.761
Preoperative hemoglobin (g/L)	135.0 (123.5-143.5)	134.0 (123.0-145.0)	0.593	131.7 ± 15.7	133.1 ± 17.5	0.510
Preoperative albumin (g/L)	39.5 ± 3.0	39.1 ± 3.2	0.246	39.4 ± 3.0	39.8 ± 3.3	0.430
Preoperative intestinal obstruction	8 (6.4)	44 (15.8)	0.009	8 (7.2)	7 (6.3)	1.000¹
Comorbidity
Cardiovascular diseases	48 (38.4)	106 (38.0)	0.938	44 (39.6)	38 (34.2)	0.441¹
Cerebrovascular disorders	11 (8.8)	38 (13.6)	0.170	10 (9.0)	10 (9.0)	1.000¹
Diabetes mellitus	16 (12.8)	41 (14.7)	0.613	13 (11.7)	12 (10.8)	1.000¹
Lung diseases	43 (34.4)	96 (34.4)	0.999	36 (32.4)	38 (34.2)	0.885¹
Liver diseases	9 (7.2)	8 (2.9)	0.045	4 (3.6)	5 (4.5)	1.000¹
Previous abdominal surgery	12 (9.6)	33 (11.8)	0.511	11 (9.9)	15 (13.5)	0.523¹
History of smoking	47 (37.6)	81 (29.0)	0.087	39 (35.1)	36 (32.4)	0.761¹
Height of tumor from anal verge (cm)	10 (8.0-13.5)	10 (6.0-10.0)	0.005	10 (8.0-12.0)	10 (8.0-12.0)	0.754
Preventive stoma	23 (18.4)	111 (39.8)	0.000	22 (19.8)	23 (20.7)	1.000¹
ASA score			0.340			0.602
I	0	1 (0.4)		0	0
II	102 (81.6)	214 (76.7)		90 (81.1)	93 (83.8)
III	23 (18.4)	64 (22.9)		21 (18.9)	18 (16.2)
Classification of NYHA heart function			0.837			0.893
I	77 (61.6)	170 (60.9)		67 (60.4)	68 (61.3)
II	48 (38.4)	106 (38.0)		44 (39.6)	43 (38.7)
III	0	3 (1.1)		0	0
BMI (kg/m²)	24.2 (22.8-25.9)	24.2 (22.1-26.7)	0.780	24.5 ± 2.8	24.6 ± 3.5	0.795
Differentiation			0.053			0.317
Low	3 (2.4)	37 (13.3)		3 (2.7)	4 (3.6)
Medium	114 (91.2)	218 (78.1)		102 (91.9)	95 (85.6)
High	8 (6.4)	24 (8.6)		6 (5.4)	12 (10.8)
Maximum tumor diameter (cm)	4 (3.0-5.0)	4 (3.5-5.0)	0.128	4 (3.0-5.0)	4 (3.0-5.0)	0.693
Pathological T stage			0.693			0.925
Tis	0	2 (0.7)		0	2 (1.8)
1	10 (8.0)	15 (5.4)		9 (8.1)	7 (6.3)
2	34 (27.2)	70 (25.1)		32 (28.8)	26 (23.4)
3	74 (59.2)	185 (66.3)		64 (57.7)	74 (66.7)
4a	7 (5.6)	7 (2.5)		6 (5.4)	2 (1.8)
Pathological N stage			0.046			0.534
0	80 (64.0)	154 (55.2)		69 (62.2)	72 (64.9)
1a	19 (15.2)	38 (13.6)		18 (16.2)	17 (15.3)
1b	13 (10.4)	38 (13.6)		12 (10.8)	12 (10.8)
1c	0	7 (2.5)		0	2 (1.8)
2a	8 (6.4)	19 (6.8)		8 (7.2)	6 (5.4)
2b	5 (4.0)	23 (8.2)		4 (3.6)	2 (1.8)
Pathological TNM stage			0.140			0.712
0	0	2 (0.7)		0	2 (1.8)
I	34 (27.2)	69 (24.7)		31 (27.9)	28 (25.2)
IIA	43 (34.4)	81 (29.0)		36 (32.4)	41 (36.9)
IIB	3 (2.4)	2 (0.7)		2 (1.8)	1 (0.9)
IIIA	9 (7.2)	15 (5.4)		9 (8.1)	5 (4.5)
IIIB	30 (24.0)	85 (30.5)		28 (25.2)	31 (27.9)
IIIC	6 (4.8)	25 (9.0)		5 (4.5)	3 (2.7)

¹McNemar’s test.

RALAR: Robot-assisted low anterior resection; LALAR: Laparoscopic-assisted low anterior resection; ASA: American Society of Anesthesiologists; NYHA: New York Heart Association; BMI: Body mass index.

Full Size Table

Table 2 Perioperative outcomes, n (%) or median (interquartile range)

	RALAR, n = 111	LALAR, n = 111	P value
Conversion to laparotomy	0	2 (1.8)	0.498²
Approximate intraoperative blood loss (mL)	50 (20-50)	50 (30-50)	0.276
Intraoperative blood transfusion	4 (3.6)	3 (2.7)	1.000¹
Distal resection margin			1.000²
Involved	0	1 (0.9)
Harvested lymph nodes	14 (11-16)	13 (11-17)	0.627
Harvested positive lymph nodes	0 (0-1)	0 (0-1)	0.317
Duration of surgery (min)	187 (160-215)	185 (155-230)	0.977
Intraoperative dose of sufentanil (μg/kg/min)	0.0050 (0.0040-0.0062)	0.0048 (0.0040-0.0064)	0.948
Time to first flatus (d)	2(2-2)	3 (3-3)	0.000
Time to first fluid diet (d)	4 (3-4)	5 (4-6)	0.001
Postoperative indwelling catheter time (d)	2 (1-3)	4 (3-5)	0.000
Total cost of hospitalization (dollars)	10777 (10780-11850)	10550 (8766-11715)	0.012
Length of hospital stay after surgery (d)	5 (5-7)	7 (6-8)	0.009
Readmission within 30 d after operation	1 (0.9)	1 (0.9)	1.000¹
Reoperation within 30 d after operation	0	1 (0.9)	1.000²

¹McNemar’s test.

²Fisher’s exact test.

RALAR: Robot-assisted low anterior resection; LALAR: Laparoscopic-assisted low anterior resection.

Full Size Table

Table 3 Complications within 30 d after surgery, n (%)

	RALAR (n = 111)					LALAR (n = 111)					P value	P value
	I	II	IIIa	IIIb	Overall	I	II	IIIa	IIIb	Overall	Overall	≥ III
Overall	0	14	1	0	15 (13.5)	3	7	2	2	14 (12.6)	1.000¹	0.375¹
Anastomotic leakage	0	12	1	0	13 (11.7)	1	6	0	2	9 (8.1)	0.481¹	1.000¹
Anastomotic stenosis	0	0	0	0	0	2	0	0	0	2 (1.8)	0.498²
Intestinal obstruction	0	1	0	0	1 (0.9)	0	2	1	0	3 (2.7)	0.625¹	1.000²
Intraabdominal infection	0	2	0	0	2 (1.8)	0	2	0	1	3 (2.7)	1.000¹	1.000²
Hemoperitoneum	0	0	0	0	0	0	0	1	0	1 (0.9)	1.000²	1.000²
Pneumonia	0	0	0	0	0	0	2	0	0	2 (1.8)	0.498²
Pulmonary atelectasis	0	0	0	0	0	4	0	0	0	4 (3.6)	0.122²
Venous thrombosis	0	1	0	0	1 (0.9)	0	0	0	0	0	1.000²

¹McNemar’s test.

²Fisher’s exact test.

RALAR: Robot-assisted low anterior resection; LALAR: Laparoscopic-assisted low anterior resection.

Full Size Table

Table 4 Subgroup analysis of anastomotic leakage, n (%)

	Anastomotic leakage	P value
BMI ≥ 25 (kg/m²)		0.428
RALAR (n = 45)	8 (17.8)
LALAR (n = 50)	6 (12.0)
Maximum tumor diameter ≥ 6 cm		0.330¹
RALAR (n = 14)	4 (28.6)
LALAR (n = 12)	1 (8.3)

¹Fisher’s exact test.

RALAR: Robot-assisted low anterior resection; LALAR: Laparoscopic-assisted low anterior resection; BMI: Body mass index.

Full Size Table

Citation: Long SX, Wang XN, Tian SB, Bi YF, Gao SS, Wang Y, Guo XB. Robotic-assisted low anterior resection for rectal cancer shows similar clinical efficacy to laparoscopic surgery: A propensity score matched study. World J Gastrointest Surg 2024; 16(6): 1558-1570
URL: https://www.wjgnet.com/1948-9366/full/v16/i6/1558.htm
DOI: https://dx.doi.org/10.4240/wjgs.v16.i6.1558