Robot‐Assisted Versus Laparoscopic Surgery for Rectal Cancer: A Propensity Score‐Matched Single‐Institution Study

Abstract

ABSTRACT Background Robot‐assisted surgery (RS) is increasingly used for rectal cancer, but its clinical benefits over laparoscopic surgery (LS) remain uncertain. We compared perioperative and oncological outcomes between RS and LS after propensity score matching (PSM). Methods This single‐center retrospective study included 553 consecutive patients with clinical Stage I–III rectal adenocarcinoma who underwent RS or LS. PSM was performed using age, sex, body mass index, tumor location, neoadjuvant therapy, clinical T stage, clinical N stage, anastomosis status, and lateral pelvic lymph node dissection as covariates. The primary endpoint was 3‐year relapse‐free survival (RFS), and perioperative outcomes were secondary endpoints. Results PSM yielded 214 matched pairs. Operative time was significantly longer in the RS group than in the LS group (254 vs. 231 min; p < 0.001), whereas intraoperative blood loss was significantly lower (10 vs. 20 mL; p < 0.001). Conversion to open surgery was less frequent in the RS group (0.5% vs. 3.7%; p = 0.04). Three‐year RFS rates were comparable between the RS and LS groups (82.2% vs. 81.1%; p = 0.68), although the crude overall recurrence proportion was significantly lower in the RS group than in the LS group (15.0% vs. 22.9%; p = 0.048). Conclusions RS and LS achieved comparable mid‐term oncological outcomes in patients with Stage I–III rectal adenocarcinoma. RS was associated with a lower conversion rate and reduced intraoperative blood loss, suggesting selective perioperative advantages.