Background: In rectal cancer surgery, the evolution of treatment paradigms has spurred advancement in surgical techniques, however, the advantage of minimally invasive techniques over open surgery remains an ongoing controversy. This is a retrospective cohort study that evaluated the short-term and pathologic outcomes of rectal cancer resections performed by open, laparoscopic and robot-assisted approaches at St. Luke’s Medical Center - Quezon City and St. Luke’s Medical Center - Global City, Philippines.
Methods: Patients with rectal adenocarcinoma (cT1-3NxM0) who underwent surgical resection between July 2018 and June 2023 were selected. Primary outcomes were severe post-operative morbidity, classified as Clavien Dindo Classification (CDC) grades III and IV, and positive circumferential resection margins (CRM). Secondary outcomes included conversion to open, operative time, 30-day unplanned re-operation rates, 30-day post-operative mortality, length of hospital stay and pathologic outcomes of positive distal resection margins and adequate lymph node yield.
Results: This study included 158 patients: 69 (44%) underwent open surgery, 63 (40%) laparoscopic surgery and 26 (16%) robot assisted surgery. Severe post-operative morbidity rates were 8.7%, for open, 11.11% for laparoscopic and 7.69% for robot-assisted surgeries, with no statistically significant differences (p=0.106). Positive CRM rates were comparable across all groups: 14.49% in open, 7.94% in laparoscopic and 7.69% in robot-assisted surgeries (p=0.456). Secondary short-term and pathologic outcomes were largely consistent across groups though, laparoscopic and robot assisted surgeries resulted in a one-day reduction in hospital stay compared to the open approach.
Conclusion: All three surgical modalities have shown comparable short-term and pathologic outcomes, including post-operative morbidity and positive CRM rates. However, both the laparoscopic and robot-assisted approaches are associated with a reduction in hospital stay by one day.