Robotic beyond total mesorectal excision for primary rectal cancer: A comparison of Short-term outcomes with standard total mesorectal excision.

PURPOSE: Robotic total mesorectal excision (R-TME) is widely used to treat rectal cancer; however, data on robotic beyond TME (R-bTME) remain limited. The present study compared the short-term outcomes between robotic standard TME (R-sTME) and R-bTME in patients with primary rectal cancer.

METHODS

This retrospective multicenter study included patients with mid-to-low rectal cancer who underwent robotic surgery between 2017 and 2024. The primary endpoint was postoperative morbidity, defined as Clavien-Dindo grade ≥ II.

RESULTS

Of the 462 patients, 391 underwent R-sTME, and 71 underwent R-bTME. In the R-bTME group, the resected sites most commonly involved the lateral compartment (72%), particularly lateral lymph nodes (63%), followed by the anterior compartment (18%), where uterine resection was most frequent, and the posterior compartment (11%), predominantly involving the hypogastric nerve. Overall morbidity was higher in the R-bTME group than in the R-sTME group (26.8% vs. 16.4%), primarily due to increased urinary dysfunction. However, the rates of severe complications (Clavien-Dindo grade ≥ III), infectious complications, anastomotic leakage, and conversion were comparable between the groups. The rate of positive radial margin (RM) was higher in the R-bTME group than in the R-sTME group (8.5% vs. 1.0%), reflecting more advanced local disease.

CONCLUSIONS

R-bTME is feasible for advanced primary rectal cancer when performed in select patients at experienced centers.