Comparative outcomes of laparoscopic and robotic anterior rectal resection for cM0 mid-low rectal adenocarcinoma: A 10-year retrospective analysis of patients with a minimum 5-year follow-up.

Over the past two decades, minimally invasive techniques have progressively replaced open surgery for mid-low rectal cancer. While randomized clinical trials (RCTs) supported this shift, they did not find a clear advantage for laparoscopic (LAR) or robotic anterior rectal resection (RAR). Given the challenges in conducting new RCTs with long-term follow-up, retrospective analyses from high-volume centers offer valuable real-world evidence. We retrospectively reviewed a prospectively maintained database of patients with cM0 mid-low rectal adenocarcinoma who underwent LAR or RAR at Humanitas San Pio X Hospital, between January 2010 and December 2019. The primary endpoint was 5-year disease-free survival (DFS); secondary outcomes included overall survival (OS), metastasis-free survival (MFS), recurrence-free survival (RFS), pathological results, perioperative recovery, and complications. Univariate analyses were performed to assess statistically significant differences between LAR and RAR using the Mann–Whitney U and Chi-Square tests; a multivariate analysis was then performed to assess the robustness of the results. The overall 5-year DFS was 77.8%, with rates of 74.2% for LAR and 81.7% for RAR; Kaplan–Meier analysis revealed no significant difference between groups. OS, MFS, RFS, R0 resection rates, and circumferential resection margin positivity were comparable. RAR was associated with faster postoperative recovery—earlier return of bowel function, lower postoperative day 1 pain scores, and reduced C-reactive protein levels—albeit with slightly longer operative times. Early and late complication rates, including low anterior resection syndrome, were similar. According to our results, RAR is a safe and effective alternative to LAR for mid-low rectal adenocarcinoma, achieving equivalent long-term oncological outcomes while offering enhanced short-term recovery benefits.