Elective surgery in rectal cancer: long term results of a German network comparison of open, laparoscopic, and robotic surgery
Menée à partir de données allemandes portant sur 24 725 patients atteints d'un cancer du rectum, cette étude compare les résultats à long terme de différentes techniques chirurgicales (laparoscopique, ouverte ou robotique)
Introduction: Resection plays a pivotal role in the treatment of rectal cancer. The aim of this study is to compare the long-term outcomes of laparoscopic, open surgical and robotic approaches.
Material and Methods: The study cohort contains data of 24,725 patients with rectal cancer and curative surgery between 2010-2022 from a pooled database of cancer registries of ten German federal states. Primary outcome was overall survival (OS). Secondary outcomes were cumulative loco-regional recurrence (CLR) and recurrence free survival (RFS) calculated via univariable and multivariable analyses, and matched-pair analyses.
Results: Of the 24,725 patients, 12,561 (50.8%) were treated with open, 11,248 (45.5%) with laparoscopic and 916 patients (3.7%) with robotic-assisted resections. In multivariable Cox regression analysis, OS was higher in the minimal invasive surgery groups compared to the open surgery group with a HR of 0.775 (p<0.001) for the laparoscopic and HR of 0.768 (p=0.006) for the robotic group. A comparison of robotic to open surgery regarding RFS showed a significant difference in favour of robotic surgery in multivariable Cox regression (HR 0.834, p=0.046). The rate of CLR was lower in the robotic compared to the laparoscopic surgery group. Additionally, we found a lower conversion rate in the robotic group as compared to the laparoscopic group.
Conclusion: These findings from real-life data confirm current recommendations for minimal invasive rectal resection. There was a trend towards better outcomes after robotic compared to laparoscopic surgery. However, further studies are needed to investigate this issue and to provide definitive evidence.
European Journal of Surgical Oncology , résumé, 2026