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Background <p>Although robotic surgery for rectal cancer has demonstrated favorable short-term outcomes, its mid-term benefits remain unclear. Moreover, randomized controlled trials have not evaluated its effectiveness in real-world settings.</p> Methods <p>This study included patients diagnosed with stage I–III middle or lower rectal adenocarcinoma who underwent minimally invasive surgery between 2018 and 2021 at 16 hospitals in Japan. The inverse probability of treatment weighting method based on propensity score was used to adjust for confounding factors. The primary outcome was the 3-year relapse-free survival (RFS).</p> Results <p>Of the 1053 patients, 536 underwent robotic surgery and 517 underwent laparoscopic surgery. The mean operative time was longer in the robotic group (robotic: 435&#xa0;min vs. laparoscopic: 366&#xa0;min). No significant difference was observed in Clavien-Dindo Grade II or higher any complications (robotic: 28.4% vs. laparoscopic: 32.0%, risk ratio [RR] 0.89, 95% confidence interval [CI]: 0.72–1.09). The rate of pathological complete resection was significantly higher in the robotic group (robotic: 98.2% vs. laparoscopic: 95.3%, RR 1.03, 95% CI 1.00–1.06). The 3-year RFS was significantly better in the robotic group (robotic: 83.6% vs. laparoscopic: 78.2%, hazard ratio [HR] 0.72, 95% CI: 0.53–0.99), and the 3-year overall survival also showed a favorable trend in the robotic group (robotic: 94.4% vs. laparoscopic: 90.6%; HR 0.60, 95% CI 0.35–1.03). Subgroup analysis indicated that robotic surgery for rectal cancer may be more effective in male patients or those with T4 tumors.</p> Conclusion <p>Robotic surgery for rectal cancer may be associated with a higher complete resection rate and improved 3-year RFS compared with conventional laparoscopic surgery in a real-world setting.</p> Graphical abstract <p></p>

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Robotic surgery enhances patients’ survival in rectal cancer: a propensity score—weighted multicenter cohort study

  • 期刊论文

  • 发表日期：

    2025年10月3日

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  • Ryosuke Mizuno,
  • Ryosuke Okamura,
  • Atsushi Takayama,
  • Kentaro Goto,
  • Yoshiro Itatani,
  • Susumu Inamoto,
  • Takehito Yamamoto,
  • Rei Mizuno,
  • Ryo Takahashi,
  • Nobu Oshima,
  • Tetsuya Shiota,
  • Masahiro Yamada,
  • Ryo Matsusue,
  • Tadayoshi Yamaura,
  • Mami Yoshitomi,
  • Teppei Murakami,
  • Kae Okoshi,
  • Yasunori Deguchi,
  • Satoshi Nagayama,
  • Keiji Nagata,
  • Koya Hida,
  • Koji Kawakami,
  • Kazutaka Obama

摘要

Background

Although robotic surgery for rectal cancer has demonstrated favorable short-term outcomes, its mid-term benefits remain unclear. Moreover, randomized controlled trials have not evaluated its effectiveness in real-world settings.

Methods

This study included patients diagnosed with stage I–III middle or lower rectal adenocarcinoma who underwent minimally invasive surgery between 2018 and 2021 at 16 hospitals in Japan. The inverse probability of treatment weighting method based on propensity score was used to adjust for confounding factors. The primary outcome was the 3-year relapse-free survival (RFS).

Results

Of the 1053 patients, 536 underwent robotic surgery and 517 underwent laparoscopic surgery. The mean operative time was longer in the robotic group (robotic: 435 min vs. laparoscopic: 366 min). No significant difference was observed in Clavien-Dindo Grade II or higher any complications (robotic: 28.4% vs. laparoscopic: 32.0%, risk ratio [RR] 0.89, 95% confidence interval [CI]: 0.72–1.09). The rate of pathological complete resection was significantly higher in the robotic group (robotic: 98.2% vs. laparoscopic: 95.3%, RR 1.03, 95% CI 1.00–1.06). The 3-year RFS was significantly better in the robotic group (robotic: 83.6% vs. laparoscopic: 78.2%, hazard ratio [HR] 0.72, 95% CI: 0.53–0.99), and the 3-year overall survival also showed a favorable trend in the robotic group (robotic: 94.4% vs. laparoscopic: 90.6%; HR 0.60, 95% CI 0.35–1.03). Subgroup analysis indicated that robotic surgery for rectal cancer may be more effective in male patients or those with T4 tumors.

Conclusion

Robotic surgery for rectal cancer may be associated with a higher complete resection rate and improved 3-year RFS compared with conventional laparoscopic surgery in a real-world setting.

Graphical abstract