Long-term functional and prognostic outcomes of robotic intersphincteric resection for treating low rectal cancer: a single-center retrospective study

Abstract

Intraoperative and postoperative data collected from patients with low rectal cancer who had undergone robotic and laparoscopic intersphincteric resection (ISR) procedures were retrospectively analyzed to evaluate factors linked to anastomotic leakage and postoperative recovery of urinary function, bowel control, and long-term prognosis. This single-center study enrolled patients with low rectal cancer who had undergone robotic ISR (n = 150) or laparoscopic ISR (n = 150) from January 2016 to July 2019. The respective mean tumor distances from the anal margin in the robotic and laparoscopic ISR groups were 3.94 ± 0.48 cm and 5.66 ± 0.47 cm, while the mean times to postoperative catheter removal in these respective groups were 4.9 ± 1.4 days and 5.3 ± 1.6 days (P = 0.007). Binary logistic regression analyses indicated that a higher BMI (≥ 25 kg/m2), diabetes, the absence of left colic artery presentation, T3 pathological T stage, the absence of temporary ileostomy, and DRM (distal resection margin) < 1 cm were linked to a greater likelihood of postoperative anastomotic leakage. Relative to patients in the laparoscopic group, those in the robotic ISR group exhibited better anal and urinary function from 6 months postoperatively, as indicated by a lower frequency of bowel movements, reduced LARS (The Low Anterior Resection Syndrome) severity, and lower IPSS (the International Prostate Symptom Score) scores. Five-year overall and disease-free survival did not differ significantly between the groups. These results highlight the promise of robotic ISR as an approach to managing cases of low and ultra-low rectal tumors, providing a safe and feasible alternative to conventional laparoscopic ISR treatment.