Robot-assisted Versus Laparoscopic Surgery For Mid-low Rectal Cancer:A Prospevtive Randomised Controlled Trial

Objective To compare the short-term and long-term outcomes of robotic and laparoscopic radical resection for mid and low rectal cancer.Methods This was a prospevtive randomised Controlled study,according to the inclusion criteria and exclusion criteria,130 patients with mid and low rectal cancer(up to 12 cm from the anal verge)enrolled in colonrectal surgery of the First Affiliated Hospital of Nanchang University from Oct.2016 to Sep.2018 were prospectively included,according to computer generated random numble method,the patients were randomly devided into robot group(n=66)and laparoscopy group(n=64),undergone either robotic surgery or laparoscopic surgery,the demographic parameters,short-term and long-term outcomes were compared after all the patients,datas were collected and followed up.Results Operations were successfully performed in all patients,there was one patient the postoperative pathology confirmed the diagnosis of rectal adenoma was excluded in the robot group,there was no statistical significance in age,sex,BMI,ASA classification,the distance from tumor to anal verge,CEA,CA199 between two groups,(P>0.05).Robotic surgery was found to be association with less blood loss than laparoscopic surgery[(73.4?49.7)ml vs.(119.1?65.7)ml,P < 0.05],there was no statistical significance in surgical procedures,operation time,time to first flatus,time to first liquid intake,time to remove catheter and postoperative hopital stay between two groups(P>0.05),the patient conversion to open surgery was not found in either groups,the postoperative complication rate was lower in robotic group(10.8%)compared to laparoscopic group(12.5%),but there was no statistical significance(P>0.05).The median number of harvested lymph nodes in the robotic group and laparoscopic group were 15.7?6.2 and 13.8?6.1 respectively,and no difference was found between two groups(P>0.05),one case of circumferential resection margins positivity occured in robotic group.With a median follow up of 24 months(9-31 months),The 2-year overall survival rate in robotic group was higher than laparoscopic(95.4% vs.90.6%),the 2-year diease free survival rate in robotic group also higher than laparoscopic group(90.8% vs.85.9%),but there were no significantly different(P>0.05).Conclusion Da Vinci Robotic radical resection for mid and low rectal cancer can achieve similar short-term and long-term outcomes compared to laparoscopic resection,but the Da Vinci robotic surgery was association with less blood loss,may be an effective tool to maximize the advantages of minimally invasive surgery.