{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T03:53:29Z","timestamp":1791777209641,"version":"4.3.4"},"reference-count":30,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,3,2]],"date-time":"2025-03-02T00:00:00Z","timestamp":1740873600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Robotic-assisted surgery is an attractive and promising option with unique advantages in rectal cancer surgery, but the optimal surgical approach is still debatable. Therefore, we aimed to compare the short- and long-term outcomes of the robotic-assisted approach with the laparoscopic-assisted and open approaches. Methods: A single referral center in Israel retrospectively reviewed all patients that underwent an elective rectal resection for primary non-metastatic rectal cancer between 2010 and 2020. The cohort was separated into three groups according to the surgical approach: robotic, laparoscopic, or open. Results: The cohort included 526 patients with a median age of 64 years (range 31\u201389), of whom 103 patients were in the robotic group, 144 in the open group, and 279 patients in the laparoscopic group. The robotic group had significantly more lower rectal tumors (24.3% versus 12.7% and 6%, respectively, p &lt; 0.001), more locally advanced tumors (65.6% versus 51.2% and 50.2%, respectively, p = 0.004), and higher rates of neoadjuvant radiotherapy (70.9% versus 54.2% and 39.5%, respectively, p &lt; 0.001). Conversion to an open laparotomy was more common in the laparoscopy group (23.1% versus 6.8%, respectively, p = 0.001). The open approach had higher rates of intraoperative complications (23.2% compared with 10.7% and 13.5% in the robotic and laparoscopic groups, respectively, p = 0.011), longer hospital stays (10 days compared with 7 and 8 days, respectively, p &lt; 0.001), and higher rates of postoperative complications (76% compared with 68.9% and 59.1%, respectively, p = 0.002). The groups were similar in the number of harvested lymph nodes (14) and the incidence of positive resection margins (2.1%). The 5-year overall survival in the robotic group was 92.3% compared with 90.5% and 88.3% in the laparoscopic and open groups, respectively (p = 0.12). The 5-year disease-free survival in the robotic group was 68% compared with 71% and 63%, respectively (p = 0.2). Conclusions: The robotic, laparoscopic, and open approaches had similar histopathological outcomes and long-term oncological outcomes. The open approach was associated with higher rates of perioperative morbidity. These findings suggest that the robotic approach is safe and effective in rectal cancer surgery.<\/jats:p>","DOI":"10.3390\/cancers17050859","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T04:58:17Z","timestamp":1741064297000},"page":"859","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Robotic Rectal Cancer Surgery: Perioperative and Long-Term Oncological Outcomes of a Single-Center Analysis Compared with Laparoscopic and Open Approach"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6629-453X","authenticated-orcid":false,"given":"Shachar","family":"Laks","sequence":"first","affiliation":[{"name":"Faculty of medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel"},{"name":"Department of Surgery, Wolfson Medical Center, Holon 5822012, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3701-2307","authenticated-orcid":false,"given":"Michael","family":"Goldenshluger","sequence":"additional","affiliation":[{"name":"Faculty of medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel"},{"name":"Division of Surgery, The Chaim Sheba Medical Center, Tel-Hashomer 5266202, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Lebedeyev","sequence":"additional","affiliation":[{"name":"Division of Surgery, The Chaim Sheba Medical Center, Tel-Hashomer 5266202, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin","family":"Anderson","sequence":"additional","affiliation":[{"name":"Faculty of medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ofir","family":"Gruper","sequence":"additional","affiliation":[{"name":"Faculty of medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7972-9424","authenticated-orcid":false,"given":"Lior","family":"Segev","sequence":"additional","affiliation":[{"name":"Faculty of medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel"},{"name":"Division of Surgery, The Chaim Sheba Medical Center, Tel-Hashomer 5266202, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1016\/S0140-6736(86)91510-2","article-title":"Recurrence and survival after total mesorectal excision for rectal cancer","volume":"327","author":"Heald","year":"1986","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/S1470-2045(13)70016-0","article-title":"Laparoscopic versus open surgery for rectal cancer (COLOR II): Short-term outcomes of a randomised, phase 3 trial","volume":"14","author":"Haglind","year":"2013","journal-title":"Lancet Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1073\/pnas.68.4.820","article-title":"Mutation and cancer: Statistical study of retinoblastoma","volume":"68","author":"Knudson","year":"1971","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1056\/NEJMoa1414882","article-title":"A Randomized Trial of Laparoscopic versus Open Surgery for Rectal Cancer","volume":"372","author":"Bonjer","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1001\/jama.2015.10529","article-title":"Effect of Laparoscopic-Assisted Resection vs. Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial","volume":"314","author":"Fleshman","year":"2015","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1001\/jama.2015.12009","article-title":"Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial","volume":"314","author":"Stevenson","year":"2015","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"837","DOI":"10.3346\/jkms.2015.30.7.837","article-title":"The Role of Robotic Surgery for Rectal Cancer: Overcoming Technical Challenges in Laparoscopic Surgery by Advanced Techniques","volume":"30","author":"Park","year":"2015","journal-title":"J. Korean Med. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1007\/s00464-005-0855-5","article-title":"Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer","volume":"20","author":"Pigazzi","year":"2006","journal-title":"Surg. Endosc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"21.050","DOI":"10.7812\/TPP\/21.050","article-title":"Robotic Versus Laparoscopic Surgery for Rectal Cancer: A Comprehensive Review of Oncological Outcomes","volume":"25","author":"Lam","year":"2021","journal-title":"Perm. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.1007\/s00464-016-5165-6","article-title":"Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid\u2013low rectal cancer following neoadjuvant chemoradiation therapy","volume":"31","author":"Lim","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"225","DOI":"10.4143\/crt.2014.365","article-title":"Robotic Versus Laparoscopic Surgery for Rectal Cancer after Preoperative Chemoradiotherapy: Case-Matched Study of Short-Term Outcomes","volume":"48","author":"Kim","year":"2016","journal-title":"Cancer Res. Treat."},{"key":"ref_12","doi-asserted-by":"crossref","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":"ref_13","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/SLA.0000000000005788","article-title":"Comparison of Laparoscopic Versus Robot-Assisted Surgery for Rectal Cancers","volume":"278","author":"Park","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Safiejko, K., Tarkowski, R., Koselak, M., Juchimiuk, M., Tarasik, A., Pruc, M., Smereka, J., and Szarpak, L. (2021). Robotic-Assisted vs. Standard Laparoscopic Surgery for Rectal Cancer Resection: A Systematic Review and Meta-Analysis of 19,731 Patients. Cancers, 14.","DOI":"10.3390\/cancers14010180"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1245\/s10434-010-0985-4","article-title":"The American Joint Committee on Cancer: The 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM","volume":"17","author":"Edge","year":"2010","journal-title":"Ann. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The clavien-dindo classification of surgical complications: Five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1007\/s00384-016-2586-6","article-title":"Comparative analysis focusing on surgical and early oncological outcomes of open, laparoscopy-assisted, and robot-assisted approaches in rectal cancer patients","volume":"31","author":"Kim","year":"2016","journal-title":"Int. J. Color. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1097\/SLA.0000000000001017","article-title":"Robotic low anterior resection for rectal cancer: A national perspective on short-term oncologic outcomes","volume":"262","author":"Speicher","year":"2015","journal-title":"Ann. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s12957-021-02128-2","article-title":"Comparison of robotic and laparoscopic rectal cancer surgery: A meta-analysis of randomized controlled trials","volume":"19","author":"Tang","year":"2021","journal-title":"World J. Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/SLA.0000000000003227","article-title":"Open Versus Laparoscopic Versus Robotic Versus Transanal Mesorectal Excision for Rectal Cancer: A Systematic Review and Network Meta-analysis","volume":"270","author":"Simillis","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"8304","DOI":"10.3748\/wjg.v22.i37.8304","article-title":"Conversion of laparoscopic colorectal resection for cancer: What is the impact on short-term outcomes and survival?","volume":"22","author":"Allaix","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1200\/JCO.2002.20.3.817","article-title":"Acute side effects and complications after short-term preoperative radi-otherapy combined with total mesorectal excision in primary rectal cancer: Report of a multicenter randomized trial","volume":"20","author":"Marijnen","year":"2002","journal-title":"J. Clin. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Khajeh, E., Aminizadeh, E., Moghadam, A.D., Nikbakhsh, R., Goncalves, G., Carvalho, C., Parvaiz, A., Kulu, Y., and Mehrabi, A. (2023). Outcomes of Robot-Assisted Surgery in Rectal Cancer Compared with Open and Laparoscopic Surgery. Cancers, 15.","DOI":"10.3390\/cancers15030839"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1097\/SLA.0b013e3182512df0","article-title":"The importance of blood loss during colon cancer surgery for long-term survival: An epidemiological study based on a population-based register","volume":"255","author":"Gunnarsson","year":"2012","journal-title":"Ann. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"6282","DOI":"10.1097\/JS9.0000000000001380","article-title":"The role of robotic-assisted surgery in the management of rectal cancer: A systematic review and meta-analysis","volume":"110","author":"Zhang","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1007\/s11605-014-2469-5","article-title":"Outcomes of Robotic-Assisted Colorectal Surgery Compared with Laparoscopic and Open Surgery: A Systematic Review","volume":"18","author":"Kim","year":"2014","journal-title":"J. Gastrointest. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"6338","DOI":"10.1007\/s00464-024-11210-1","article-title":"Trends and outcomes in colorectal cancer surgery: A multicenter cross-sectional study of minimally invasive versus open techniques in Germany","volume":"38","author":"Krieg","year":"2024","journal-title":"Surg. Endosc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1245\/s10434-020-08976-8","article-title":"Impact of post-operative complications on oncologic outcomes after rectal cancer surgery: An analysis of the US rectal cancer consortium","volume":"28","author":"Gamboa","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.jss.2024.05.032","article-title":"Association of Surgical Approaches and Outcomes in Total Mesorectal Excision and Margin Status for Rectal Cancer","volume":"300","author":"Mirza","year":"2024","journal-title":"J. Surg. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1097\/01.sla.0000133185.23514.32","article-title":"Anterior resection for rectal cancer with mesorectal excision: A prospective evaluation of 622 patients","volume":"240","author":"Law","year":"2004","journal-title":"Ann. Surg."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/5\/859\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:45:52Z","timestamp":1760028352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/5\/859"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,2]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["cancers17050859"],"URL":"https:\/\/doi.org\/10.3390\/cancers17050859","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,2]]}}}