{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:03:27Z","timestamp":1786982607540,"version":"build-2736575974"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Updates Surg"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Although outcomes of laparoscopic and robotic-assisted proctectomy have been compared, the superiority of one approach over another was not proven. We used the target trial methodology to emulate a randomized clinical trial comparing laparoscopic and robotic-assisted proctectomy for rectal cancer. Data from the NCDB (2015\u20132021) on patients with stage II\u2013III rectal adenocarcinoma were collected. Patients were divided into two groups: laparoscopic proctectomy (LP) and robotic-assisted proctectomy (RP). The groups were matched for baseline patient and treatment confounders to obtain balanced groups, emulating the design of a randomized trial. The primary outcome was\u00a0the pathologic outcomes of each surgical approach, including the\u00a0status of circumferential resection margins (CRM), surgical margins, and number of examined lymph nodes. Secondary outcomes included conversion to open surgery, hospital stay, and 30- and 90-day mortality. After matching, 5631 patients were included in each group. The RP and LP groups had similar rates of positive CRM (10.5% vs. 9.4%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.072), positive surgical margins (6% vs. 6.3%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.528), examined lymph nodes number (median: 15 vs. 15,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.105), 30-day mortality (0.7% vs. 0.9%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.405), 90-day mortality (1.5% vs. 1.8%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.333), and\u00a0unplanned 30-day readmission (6.6% vs. 6.2%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.477). RP was associated with shorter hospital stay (median: 4 vs. 5\u00a0days,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and lower rate of conversion to open surgery (5.8% vs. 13.6%, OR: 0.39, 95%CI 0.34\u20130.45,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). This target trial found RP and LP for rectal cancer associated with similar clinical and pathologic outcomes. RP was associated with fewer conversions and shorter hospital stays than LP.\n                  <\/jats:p>","DOI":"10.1007\/s13304-025-02446-0","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T07:12:12Z","timestamp":1760598732000},"page":"117-126","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Target trial on the outcomes of laparoscopic compared to robotic-assisted proctectomy in stage II\u2013III rectal cancer"],"prefix":"10.1007","volume":"78","author":[{"given":"Sameh Hany","family":"Emile","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nir","family":"Horesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Oosenbrug","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebram","family":"Salama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjelli","family":"Wignakumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Strassmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8046-5753","authenticated-orcid":false,"given":"Steven D.","family":"Wexner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"2446_CR1","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s11605-008-0722-5","volume":"13","author":"IJ Park","year":"2009","unstructured":"Park IJ, Choi GS, Lim KH, Kang BM, Jun SH (2009) Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer. J Gastrointest Surg 13:275\u2013281. https:\/\/doi.org\/10.1007\/s11605-008-0722-5","journal-title":"J Gastrointest Surg"},{"key":"2446_CR2","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/s00384-023-04447-0","volume":"38","author":"PF Yang","year":"2023","unstructured":"Yang PF, Ang ZH, Badiani S, Berney CR, Morgan MJ (2023) Impact of obesity on patients undergoing surgery for rectal cancer in Australia and New Zealand. Int J Colorectal Dis 38:163. https:\/\/doi.org\/10.1007\/s00384-023-04447-0","journal-title":"Int J Colorectal Dis"},{"key":"2446_CR3","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1007\/s10151-022-02588-y","volume":"26","author":"I Darwich","year":"2022","unstructured":"Darwich I, Abuassi M, Aliyev R et al (2022) Early experience with the ARTISENTIAL\u00ae articulated instruments in laparoscopic low anterior resection with TME. 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Surg Endosc 23:2321\u20132326. https:\/\/doi.org\/10.1007\/s00464-009-0329-2","journal-title":"Surg Endosc"}],"container-title":["Updates in Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13304-025-02446-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13304-025-02446-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13304-025-02446-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T21:03:11Z","timestamp":1771275791000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13304-025-02446-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["2446"],"URL":"https:\/\/doi.org\/10.1007\/s13304-025-02446-0","relation":{},"ISSN":["2038-131X","2038-3312"],"issn-type":[{"value":"2038-131X","type":"print"},{"value":"2038-3312","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,16]]},"assertion":[{"value":"14 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Dr. Wexner is a consultant for Activ Surgical, Arthex, Baxter, Becton, Dickinson and Co., Intuitive Surgical, OstomyCure, Takeda, and Virtual Ports, has consulting agreements with stock options for consulting with GI View, OstomyCure, and Virtual Ports, is the Data Safety Monitoring Board chair of Polypid, and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc., and Unique Surgical Solutions, LLC. Drs. Emile, Horesh, Oosenbrug, Salama, Wignakumar and Strassmann do not report any conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}},{"value":"The study was not considered human subject research as it was a retrospective review of de-identified data from a national database; therefore, ethics approval was not required. Given the retrospective nature of the study, we did not involve patients or the public in the design, conduct, or reporting of the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}