{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:09:24Z","timestamp":1792512564608,"version":"4.5.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare perioperative and oncologic outcomes between robotic surgical platforms (Si vs. Xi) in rectal carcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort study of 86 robotic rectal cancer resections (Si:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200931; Xi:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200955) were analyzed at Tianjin Medical University Cancer Hospital between November 2019 and June 2024.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 86 patients with comparable baseline clinicopathological variables (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05), the Xi system showed superior perioperative efficiency: shorter operation (226.7 vs. 282.1\u2005min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010), console (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016) and docking times (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), less blood loss (83.8 vs. 155.8\u2005mL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005), and a shorter postoperative stay (7.8 vs. 9.7 days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016). On multivariable analyses, Xi remained independently associated with a shorter operative time (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), reduced blood loss (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.027), and decreased length of stay (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.038). Complication rates, lymph node yield, and short-term oncologic quality indicators (distal resection margin [DRM], circumferential resection margin [CRM], mesorectal integrity) were comparable between two systems (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). In low rectal cancers (\u2264 5\u2005cm from the anal verge) with balanced baselines, Xi achieved a higher sphincter preservation rate (90.5% vs. 55.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.049). Survival trends numerically favored Xi (3-year DFS 79.8% vs. 73.0%; OS 92.0% vs. 83.0%), but differences were not significant (DFS:\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.54; OS:\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.26). On Cox regression, TNM stage independently predicted both DFS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.041) and OS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029). However, the robotic platform (Xi vs. Si) showed no survival advantage (DFS: HR\u2009=\u20091.33, 95% CI 0.53\u20133.37,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.548; OS: HR\u2009=\u20091.43, 95% CI 0.76\u20132.67,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.267).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared with Si, the Xi platform confers measurable perioperative advantages\u2014shorter operative time, less blood loss, and reduced hospitalization\u2014without compromising short-term oncologic quality or survival. In low rectal tumors, Xi may facilitate sphincter preservation under comparable baselines. Long-term outcomes appear driven primarily by disease stage rather than platform generation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2025.1668213","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T06:41:06Z","timestamp":1768977666000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Robotic evolution from Si to Xi in rectal cancer assessing operative performance and oncological outcomes"],"prefix":"10.3389","volume":"12","author":[{"given":"Wenpeng","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Colorectal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Tianjin Key Laboratory of Digestive Cancer","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinghao","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, Shenzhen People\u2019s Hospital (the Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology)","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duo","family":"Yun","sequence":"additional","affiliation":[{"name":"Cancer Center, Beijing Friendship Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiefu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Tianjin Key Laboratory of Digestive Cancer","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"101786","DOI":"10.1016\/j.suronc.2022.101786","article-title":"Optimizing outcomes of colorectal cancer surgery with robotic platforms","volume":"43","author":"Baek","year":"2022","journal-title":"Surg Oncol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1111\/ases.12087","article-title":"Robotics in general surgery: an evidence-based review","volume":"7","author":"Baek","year":"2014","journal-title":"Asian J Endosc Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e50415","DOI":"10.7759\/cureus.50415","article-title":"Advancements in robotic surgery: a comprehensive overview of current utilizations and upcoming frontiers","volume":"15","author":"Reddy","year":"2023","journal-title":"Cureus"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1007\/s00464-014-3818-x","article-title":"Robotic surgery for rectal cancer can overcome difficulties associated with pelvic anatomy","volume":"29","author":"Baek","year":"2015","journal-title":"Surg Endosc"},{"key":"B5","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1007\/s11701-017-0689-x","article-title":"Multiquadrant robotic colorectal surgery: the da Vinci Xi vs Si comparison","volume":"12","author":"Protyniak","year":"2018","journal-title":"J Robot Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1001\/jama.2017.7219","article-title":"Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial","volume":"318","author":"Jayne","year":"2017","journal-title":"JAMA"},{"key":"B7","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1097\/SLA.0000000000005788","article-title":"Comparison of laparoscopic versus robot-assisted surgery for rectal cancers: the COLRAR randomized controlled trial","volume":"278","author":"Park","year":"2023","journal-title":"Ann Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1001\/jama.2025.8123","article-title":"Robotic vs laparoscopic surgery for middle and low rectal cancer: the REAL randomized clinical trial","volume":"334","author":"Feng","year":"2025","journal-title":"JAMA"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1507323","DOI":"10.3389\/fonc.2024.1507323","article-title":"Comparative study of robotic-assisted vs. Laparoscopic surgery for colorectal cancer: a single-center experience","volume":"14","author":"Wang","year":"2025","journal-title":"Front Oncol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1755","DOI":"10.1007\/s00384-018-3153-0","article-title":"Short- and long-term outcomes of robotic-assisted laparoscopic surgery for rectal cancer: results of a single high-volume center in Japan","volume":"33","author":"Yamaguchi","year":"2018","journal-title":"Int J Colorectal Dis"},{"key":"B11","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1097\/SLE.0000000000000320","article-title":"Is da Vinci Xi better than da Vinci Si in robotic rectal cancer surgery? 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