Abstract
PURPOSE: The present study aimed to objectively evaluate robot-assisted abdominoperineal resection (APR) in comparison with open APR, in terms of operative elements and initial oncological outcomes. METHODS: A total of 118 patients with lower rectal adenocarcinoma who had undergone curative APR were consecutively enrolled between June 2010 and June 2016, i.e., robot-assisted group (n = 40) and open group (n = 78). RESULTS: Transabdominal extralevator muscle excision was more frequently performed in the robot-assisted group than in the open group (68% vs. 42%, P = 0.012). In the robot-assisted group, the pain score at one day after surgery was less than in the open group, and the resumption of bowel function was earlier (P = 0.043 and P = 0.002, respectively). The occurrence of circumferential resection margin involvement (CRM+) was more than 5 times greater in the open group than in the robot-assisted group, presenting a marginal significance (P = 0.057). Although important postoperative morbidity did not generally differ between the 2 groups, voiding difficulty and male sexual dysfunction appeared to be encountered more frequently in the open group than in the robot-assisted group. CONCLUSION: The robot-assisted APR facilitated transabdominal extralevator excision and bowel recovery and demonstrated a trend towards reduced CRM+.