• Jin Kim, Se-Jin Baek, Dong-Woo Kang, Young-Eun Roh, Jae Won Lee, Han-Deok Kwak, Jung Myun Kwak, and Seon-Hahn Kim.
• 1Department of Surgery, Korea University College of Medicine, Seoul, Korea 2Department of Statistics, Korea University College of Political Science and Economics, Seoul, Korea.
• Dis. Colon Rectum. 2017 Mar 1; 60 (3): 266-273.

BackgroundRobotic total mesorectal excision for rectal cancer has rapidly increased and has shown short-term outcomes comparable to conventional laparoscopic total mesorectal excision. However, data for long-term oncologic outcomes are limited.ObjectiveThe aim of this study is to evaluate long-term oncologic outcomes of robotic total mesorectal excision compared with laparoscopic total mesorectal excision.DesignThis was a retrospective study.SettingsThis study was conducted in a tertiary referral hospital.PatientsA total of 732 patients who underwent totally robotic (n = 272) and laparoscopic (n = 460) total mesorectal excision for rectal cancer were included in this study.Main Outcome MeasuresWe compared clinicopathologic outcomes of patients. In addition, short- and long-term outcomes and prognostic factors for survival were evaluated in the matched robotic and laparoscopic total mesorectal excision groups (224 matched pairs by propensity score).ResultsBefore case matching, patients in the robotic group were younger, more likely to have undergone preoperative chemoradiation, and had a lower tumor location than those in the laparoscopic group. After case matching most clinicopathologic outcomes were similar between the groups, but operative time was longer and postoperative ileus was more frequent in the robotic group. In the matched patients excluding stage IV, the overall survival, cancer-specific survival, and disease-free survival were better in the robotic group, but did not reach statistical significance. The 5-year survival rates for robotic and laparoscopic total mesorectal excision were 90.5% and 78.0% for overall survival, 90.5% and 79.5% for cancer-specific survival, and 72.6% and 68.0% for disease-free survival. In multivariate analysis, robotic surgery was a significant prognostic factor for overall survival and cancer-specific survival (p = 0.0040, HR = 0.333; p = 0.0161, HR = 0.367).LimitationsThis study has the potential for selection bias and limited generalizability.ConclusionsRobotic total mesorectal excision for rectal cancer showed long-term survival comparable to laparoscopic total mesorectal excision in this study. Robotic surgery was a good prognostic factor for overall survival and cancer-specific survival, suggesting potential oncologic benefits.

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