{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:41:00Z","timestamp":1792100460145,"version":"4.4.0"},"reference-count":30,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Surgery for rectal cancer has evolved, with the adoption of minimally invasive and robotic techniques. This study evaluates whether robotic surgery for rectal cancer produces an improvement in perioperative and oncological outcomes compared with open and laparoscopic surgery in a retrospective analysis. Methods: A single-center retrospective study included 212 patients with histologically confirmed rectal cancer treated between 2012 and 2021. The patients were grouped by surgical approach: robotic (RR, n = 62), laparoscopic (LR, n = 68), and open resection (OR, n = 82). The primary endpoints were total mesorectal excision (TME) quality, operative time, and hospital stay. The secondary endpoints included the lymph node yield, the conversion rate, and the 5-year survival outcomes (OS and DFS), analyzed via Kaplan\u2013Meier curves and proportional hazards models. Results: The TME quality was high across the groups (RR: 91.9%, LR: 86.8%, OR: 95.1%). The median operative time was the longest in the RR group (304 min vs. 221\u2013222 min in LR\/OR). Robotic surgery resulted in shorter median hospital stays (10 (RR) vs. 14 (LR) vs. 14 (OR) days) and a lower conversion rate (3.2% vs. 14.7% in LR). The lymph node yield was highest in the LR group (27.9), followed by the RR (25.5) and OR (23.0) groups. Postoperative pneumonia was most common in the OR group (12.2%), and bladder dysfunction occurred only in the OR group (4.9%). The five-year OS and DFS did not differ notably between the groups. Conclusions: Robotic surgery offers advantages in short-term outcomes, including fewer complications, shorter hospitalization, and lower conversion rates, despite longer operative times. Its oncological efficacy is equal compared to those of laparoscopic and open surgery.<\/jats:p>","DOI":"10.3390\/jcm14196743","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T12:15:31Z","timestamp":1758716131000},"page":"6743","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Robotic Versus Laparoscopic Versus Open Surgery for Rectal Cancer"],"prefix":"10.3390","volume":"14","author":[{"given":"Zsolt","family":"Madarasz","sequence":"first","affiliation":[{"name":"Department of Surgery, Medical School and University Medical Center OWL, Bielefeld University, Campus Lippe, 32756 Detmold, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Leitz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical School and University Medical Center OWL, Bielefeld University, Campus Lippe, 32756 Detmold, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8152-8017","authenticated-orcid":false,"given":"Miljana","family":"Vladimirov","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical School and University Medical Center OWL, Bielefeld University, Campus Lippe, 32756 Detmold, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6414-9754","authenticated-orcid":false,"given":"Kira","family":"Baginski","sequence":"additional","affiliation":[{"name":"Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0241-9951","authenticated-orcid":false,"given":"Annika","family":"Hoyer","sequence":"additional","affiliation":[{"name":"Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Hoeppner","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical School and University Medical Center OWL, Bielefeld University, Campus Lippe, 32756 Detmold, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Nimczewski","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical School and University Medical Center OWL, Bielefeld University, Campus Lippe, 32756 Detmold, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krzysztof","family":"Nowakowski","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical School and University Medical Center OWL, Bielefeld University, Campus Lippe, 32756 Detmold, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"ref_1","first-page":"689","article-title":"Advances in the diagnosis and treatment of rectal cancer","volume":"13","author":"Zhang","year":"2022","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_2","first-page":"12","article-title":"Open rectal surgery: Outcomes and challenges","volume":"56","author":"Batool","year":"2018","journal-title":"Int. J. Surg."},{"key":"ref_3","first-page":"485","article-title":"Minimally invasive surgery for rectal cancer: Current status and future perspectives","volume":"4","author":"Toiyama","year":"2020","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/S2468-1253(24)00273-5","article-title":"Laparoscopy-assisted versus open surgery for low rectal cancer (LASRE): 3-year survival outcomes of a multicentre, randomised, controlled, non-inferiority trial","volume":"10","author":"Jiang","year":"2025","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_5","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_6","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1097\/SLA.0000000000002523","article-title":"Robotic versus laparoscopic minimally invasive surgery for rectal cancer: A systematic review and meta-analysis of randomized controlled trials","volume":"267","author":"Prete","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_7","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_8","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1111\/codi.15084","article-title":"Robotic vs. Laparoscopic Total Mesorectal Excision for Rectal Cancers: Has a Paradigm Change Occurred? A Systematic Review by Updated Meta-Analysis","volume":"22","author":"Gavriilidis","year":"2020","journal-title":"Colorectal Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1016\/S0140-6736(05)66545-2","article-title":"Short-term endpoints of conventional vs laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): Multicentre, randomised controlled trial","volume":"365","author":"Guillou","year":"2005","journal-title":"Lancet"},{"key":"ref_10","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_11","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_12","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_13","doi-asserted-by":"crossref","unstructured":"Khajeh, E., Aminizadeh, E., Dooghaie Moghadam, A., 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_14","doi-asserted-by":"crossref","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":"ref_15","doi-asserted-by":"crossref","unstructured":"Zou, J., Zhu, H., Tang, Y., Huang, Y., Chi, P., and Wang, X. (2025). Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. BMC Surg., 25.","DOI":"10.1186\/s12893-025-02805-z"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.jviscsurg.2024.01.004","article-title":"Meta-Analysis of Randomized Clinical Trials Comparing Robotic versus Laparoscopic Surgery for Mid-Low Rectal Cancers","volume":"161","author":"Slim","year":"2024","journal-title":"J. Visc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"14","DOI":"10.23922\/jarc.2019-037","article-title":"Robotic Surgery for Rectal Cancer: Operative Technique and Review of the Literature","volume":"4","author":"Katsuno","year":"2020","journal-title":"J. Anus Rectum Colon"},{"key":"ref_18","unstructured":"Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2025, April 04). S3-Leitlinie Kolorektales Karzinom, Available online: https:\/\/www.leitlinienprogramm-onkologie.de."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"zrae071","DOI":"10.1093\/bjsopen\/zrae071","article-title":"Total mesorectal excision quality in rectal cancer surgery affects local recurrence rate but not distant recurrence and survival: Population-based cohort study","volume":"8","author":"Collin","year":"2024","journal-title":"BJS Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1007\/s00464-024-11374-w","article-title":"Short- and Long-Term Outcomes of Robotic and Laparoscopic Surgery in Rectal Cancer: A Propensity Score-Matched Analysis","volume":"39","author":"Takamizawa","year":"2025","journal-title":"Surg. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_22","first-page":"741","article-title":"Decision-making in robotic versus laparoscopic rectal cancer surgery: Patient factors and pelvic anatomy","volume":"14","author":"Alawfi","year":"2020","journal-title":"J. Robot. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s00464-019-07361-1","article-title":"Functional Outcomes after Laparoscopic versus Robotic-Assisted Rectal Resection: A Systematic Review and Meta-Analysis","volume":"35","author":"Kowalewski","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1186\/s12957-021-02432-x","article-title":"The efficacy of ileostomy after laparoscopic rectal cancer surgery: A meta-analysis","volume":"19","author":"Mu","year":"2021","journal-title":"World J. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2518","DOI":"10.1016\/j.ejso.2022.06.025","article-title":"Defunctioning stoma in rectal cancer surgery\u2014A risk factor for Low Anterior Resection Syndrome?","volume":"48","author":"Pieniowski","year":"2022","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Wang, Y., Wang, X., Huang, S., Zhu, H., and Huang, Y. (2024). Impact of diversion ileostomy on postoperative complications and recovery in the treatment of locally advanced upper-half rectal cancer. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-78409-z"},{"key":"ref_27","first-page":"21","article-title":"Robot-Assisted vs. Laparoscopic Rectal Cancer Resection: A Narrative Review of Oncological Outcomes, Functional Results, and Future Perspectives","volume":"9","author":"Ueda","year":"2025","journal-title":"Mini-Invasive Surg."},{"key":"ref_28","first-page":"1552","article-title":"Robotic Rectal Cancer Surgery: Comparative Study of the Impact of Obesity on Early Outcomes","volume":"107","author":"Peacock","year":"2020","journal-title":"Br. J. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chen, E., Chen, L., and Zhang, W. (2025). Robotic-Assisted Colorectal Surgery in Colorectal Cancer Management: A Narrative Review of Clinical Efficacy and Multidisciplinary Integration. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1502014"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"109134","DOI":"10.1016\/j.surg.2024.109134","article-title":"Cost-Effectiveness of Robotic Compared with Laparoscopic Rectal Resection: Results from the Spanish Prospective National Trial ROBOCOSTES","volume":"180","author":"Pellino","year":"2025","journal-title":"Surgery"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6743\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:54Z","timestamp":1760035734000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6743"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,24]]},"references-count":30,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14196743"],"URL":"https:\/\/doi.org\/10.3390\/jcm14196743","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,24]]}}}