Evaluation of pilot experience with robotic-assisted proctectomy and coloanal anastomosis for rectal cancer

Background Robotic-assisted proctectomy with coloanal anastomosis (RPCA) is an innovative technique of pelvic dissection for low rectal cancer. Our objective was to evaluate our pilot experience with this procedure compared with open proctectomy with coloanal anastomosis (OPCA). Methods We performed a retrospective 5-year review of all consecutive cases of RPCA and OPCA performed at our institute. We focused on tumour characteristics, quality of surgery, analgesic requirements, average length of hospital stay (LOS), complications and long-term outcomes. Results Three patients underwent RPCA and 25 had OPCA. The average duration of surgery was similar (288 min for RPCA v. 285 min for OPCA). Four patients in the OPCA group had positive or very close margins, and 2 had a mesorectal defect less than 5 mm. The average LOS was 6.66 and 9.29 days in the RPCA and OPCA groups, respectively, and the average duration of epidural or patient-controlled anesthesia was 2.67 and 5.16 days, respectively. We did not perform a statistical comparison because of the discordant size and sex distribution between the groups. There were no perioperative complications in the RPCA group, and all patients had negative margins and adequate lymph node retrievals with no long-term complications or recurrence recorded so far. Conclusion Our very early experience with RPCA is quite encouraging, suggesting that it is a safe alternative to OPCA with a similar duration and the added benefits of a minimally invasive procedure, including decreased LOS and reduced postoperative analgesic requirements.