• Thijs A Burghgraef, CrollaRogier M P HRMPH, Paul M Verheijen, Milad Fahim, van GelovenAnna A WAAW, LeijtensJeroen W AJWA, Apollo Pronk, Anke B Smits, VerdaasdonkEmiel G GEGG, and ConstenEsther C JECJ.
• Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands Department of Surgery, Amphia Hospital, Breda, the Netherlands Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands Department of Surgery, Tergooi Hospital, Hilversum, the Netherlands Department of Surgery, Laurentius Hospital, Roermond, the Netherlands Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands.
• Dis. Colon Rectum. 2021 Aug 17.

BackgroundThe superiority of robot-assisted over laparoscopic total mesorectal excision has not been proven. Most studies do not take into account the learning curve while comparing the surgical technique.ObjectiveThis study aims to compare laparoscopic with robot-assisted total mesorectal excision performed by surgeons who completed the learning curve of the technique.DesignThis is a multicenter retrospective propensity score-matched analysis.SettingsThe study was performed in two large dedicated robot-assisted hospitals and five large dedicated laparoscopic hospitals.PatientsPatients were included if they underwent a robot-assisted or laparoscopic total mesorectal excision for rectal cancer with curative intent, in a dedicated center for the minimal invasive technique between January 1, 2015 and December 31, 2017.InterventionsWe compared robot-assisted with laparoscopic total mesorectal excision.Main Outcome MeasuresThe main outcome was conversion to laparotomy during surgery. Secondary outcomes were postoperative morbidity and positive circumferential margin.ResultsA total of 884 patients were included, and after matching 315 patients per treatment group remained. Conversion was similar between laparoscopic and robot-assisted total mesorectal excision (4.4% vs 2.5% [p=0.20]). Positive circumferential resection margin was equal (3.2% vs 4.4% [p=0.41]). Overall morbidity was comparable as well, although a lower rate of wound infections was observed in the robot-assisted group (5.7% vs 1.9% [p=0.01]). More primary anastomosis were constructed in the robot-assisted group (50.8% vs 68.3% [p<0.001]). Finally, more open procedures were performed in dedicated laparoscopic centers, with an overrepresentation of cT4N+ tumors in this group.LimitationsThis is a retrospective multicenter cohort, however propensity score matching was applied to control for confounding by indication.ConclusionsRobot-assisted and laparoscopic total mesorectal excision are equally safe in terms of short-term outcome. However, with the robot-assisted approach, more primary anastomoses were constructed, and a lower wound infection rate was observed. See Video Abstract at http://links.lww.com/DCR/B677.Copyright © 2021 The American Society of Colon and Rectal Surgeons.

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