Short-term Outcomes Of Robotic-assisted Vs Laparoscopic Total Mesorectal Excision For Rectal Cancer:A Cohort Study

Objective:To compare short-term outcomes,radical curative effect of oncology and postoperative related complications between the robotic-assisted total mesorectal excision(R-TME)and laparoscopic total mesorectal excision(L-TME).Methods:This is a retrospective study using a prospectively collected database.Patients’ records were obtained from the anorectal department of Gansu Provincial Hospital between October2016 and October 2018.A total of 387 patients were selected according to the inclusion and exclusion criteria,including 186 patients underwent R-TME,201 patients with the same histopathological stage of the tumor underwent L-TME.All operations were performed by the same surgeon.Cohort study was used to analyze the short-term outcomes,radical curative effect of oncology,and postoperative related complications of the two surgical methods.Results:The postoperative hospital stay in the R-TME group [(11.20±5.80)d vs(14.72±6.90)d,P=0.023],the first anus exhaust time [(3.28±1.64)d vs(6.01±2.77)d,P<0.001],the time of the first ingestion diet [(4.46±1.62)d vs(6.28±2.74)d,P<0.001] was shortened by nearly 3days compared with the L-TME group.The anal sphincter rate of the R-TME group was significantly higher than that of the L-TME group(84.95% vs 70.65%,P=0.001).The incidence of postoperative total complications(6.99% vs.19.40%,P<0.001),the incidence of postoperative urinary retention(2.69% vs 7.96%,P=0.022)was significantly lower in the R-TME group than that in the L-TME group.The intraoperative blood loss in the R-TME group was higher than that in the L-TME group [(175.06±110.77)mL vs(123.91±99.61)mL,P=0.031].The operation time,the number of lymph node dissection,the distance from the lower edge of the tumor to the lower margin,the residue of marginal cancer tissue,the destruction of mesenteric integrity,the classification of postoperative pain and the incidence of other postoperative related complications,there was no significant difference in two groups(P>0.05).The total cost of the R-TME group is higher than that of the L-TME group,and there is a statistically significant difference [(85623.91±13310.50)RMB ￥ vs(67356.79±17107.68)RMB￥,P <0.001].Multivariate linear regression analysis showed that when controlling the potential confounding factors affecting the operation time,intraoperative blood loss,lymph nodedissection,first anal exhaust time,postoperative hospital stay,and total cost,compared to the L-TME group,the R-TME group of postoperative hospital stay(Coe:-3.22 95% CI:-5.59~-0.85,P<0.01)and the first anal exhaust time(Coe:-2.91 95% CI:-3.72~-2.10,P<0.001)was shortened by about 3 days,of the intraoperative blood loss was more(Coe:52.21 95% CI: 17.35~87.07,P<0.01),and of the total cost was higher(Coe: 18708.08 95%CI: 13340.10~24076.06,P<0.001).Conclusions:R-TME is safe,feasible,and effective.It has the same tumor radical effect,faster postoperative short-term recovery,and lower total complications and urinary retention than L-TME.Its effect on postoperative sexual function and long-term outcomes remains to be further followed up and observed.