{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T20:48:47Z","timestamp":1784580527881,"version":"3.55.0"},"reference-count":39,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,15]],"date-time":"2025-03-15T00:00:00Z","timestamp":1741996800000},"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: Rectal cancer is a major global health issue with high morbidity and mortality rates. Local recurrence (LR) significantly impacts patient outcomes, decreasing survival rates and often necessitating extensive secondary treatments. While robot-assisted total mesorectal excision (R-TME) is becoming a preferred method for rectal cancer surgery due to its improved precision and visualisation, long-term data on LR and predictors of recurrence remain limited. This study aims to determine the 3-year LR rate following R-TME and to identify predictors of recurrence to enhance patient selection and the personalisation of treatment. Methods: This retrospective international multicentre cohort study included 1039 consecutive rectal cancer patients who underwent R-TME between 2013 and 2020, with a minimum of 3 years of follow-up. Data from tertiary colorectal centres in the United Kingdom, the Netherlands, Spain, France, Italy, and Belgium were analysed. Potential predictors of LR were identified using backward elimination, and four machine learning models were evaluated for predicting LR. Results: The 3-year LR rate was 3.8%. Significant predictors of LR included advanced clinical M-staging, length of the hospital stay, postoperative ileus, postoperative complications, pathological N-staging, the completeness of resection, and the resection margin distance. The eXtreme Gradient Boosting model performed best for LR prediction, with a final accuracy of 77.1% and an AUC of 0.76. Conclusions: R-TME in high-volume centres achieves low 3-year LR rates, suggesting that robot-assisted surgery offers oncological safety and advantages in rectal cancer management. This study underscores the importance of surgical precision, patient selection, and standardised perioperative care, supporting further investment in robotic training to improve long-term patient outcomes.<\/jats:p>","DOI":"10.3390\/cancers17060992","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T15:24:56Z","timestamp":1742225096000},"page":"992","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Analysis of Local Recurrence After Robotic-Assisted Total Mesorectal Excision (ALRITE): An International, Multicentre, Retrospective Cohort"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4707-0319","authenticated-orcid":false,"given":"Ritch T. J.","family":"Geitenbeek","sequence":"first","affiliation":[{"name":"Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands"},{"name":"Department of Surgery, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3118-0641","authenticated-orcid":false,"given":"Rauand","family":"Duhoky","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK"},{"name":"Faculty of Technology, University of Portsmouth, Portsmouth PO1 3HE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thijs A.","family":"Burghgraef","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands"},{"name":"Department of Surgery, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6667-9202","authenticated-orcid":false,"given":"Guglielmo Niccol\u00f2","family":"Piozzi","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8489-9356","authenticated-orcid":false,"given":"Shamsul","family":"Masum","sequence":"additional","affiliation":[{"name":"School of Electrical and Mechanical Engineering, University of Portsmouth, Portsmouth PO1 3HE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7183-5799","authenticated-orcid":false,"given":"Adrian A.","family":"Hopgood","sequence":"additional","affiliation":[{"name":"Faculty of Technology, University of Portsmouth, Portsmouth PO1 3HE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quentin","family":"Denost","sequence":"additional","affiliation":[{"name":"Bordeaux Colorectal Institute, Clinique Tivoli, 33300 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"van Eetvelde","sequence":"additional","affiliation":[{"name":"Department of Surgery, Universitair Ziekenhuis Brussel, 1090 Jette, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Bianchi","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Health Sciences (DISS), University of Milan San Paolo Hospital, 20142 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0415-3269","authenticated-orcid":false,"given":"Philippe","family":"Rouanet","sequence":"additional","affiliation":[{"name":"Surgery Department, Montpellier Cancer Institute (ICM), Universit\u00e9 Montpellier, 34090 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roel","family":"Hompes","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Amsterdam, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"},{"name":"Department of Surgery, Amsterdam Cancer Center, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"G\u00f3mez Ruiz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Marqu\u00e9s de Valdecilla University Hospital, 39008 Santander, Spain"},{"name":"Valdecilla Biomedical Research Institute (IDIVAL), 39011 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1559-4879","authenticated-orcid":false,"given":"Jim","family":"Briggs","sequence":"additional","affiliation":[{"name":"Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth PO1 3HE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3031-4495","authenticated-orcid":false,"given":"Jim S.","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK"},{"name":"Faculty of Health Sciences, University of Portsmouth, Portsmouth PO1 3HE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther C. J.","family":"Consten","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands"},{"name":"Department of Surgery, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the ALRITE Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.ejca.2018.07.005","article-title":"Cancer Incidence and Mortality Patterns in Europe: Estimates for 40 Countries and 25 Major Cancers in 2018","volume":"103","author":"Ferlay","year":"2018","journal-title":"Eur. J. Cancer"},{"key":"ref_2","unstructured":"(2024, October 10). Cancer Facts & Figures 2021|American Cancer Society. 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