Comparative analysis of short-term outcomes and oncological results between robotic-assisted and laparoscopic surgery for rectal cancer by multiple surgeon implementation: a propensity score-matched analysis.

Robotic-assisted surgery (RAS) is becoming increasingly common for the surgical treatment of rectal cancer. However, the use and implementation of robotic surgery remains controversial. This study aimed to compare the short-term outcomes of robotic surgery, focusing on pathological results and disease-free survival (DFS), in our cohort with initial robotic experience by multiple surgeon implementation. This retrospective study enrolled 571 patients diagnosed with rectal cancer, who were treated with chemoradiotherapy and surgery between January 2015 and December 2021. Surgical outcomes after RAS and laparoscopic surgery (LS) were compared using a propensity score-matching (PSM) analysis. After matching, 200 patients (100 in each group) were included. The median operative time was significantly longer in the RAS group than in the LS group (p < 0.001). The conversion and morbidity rates were similar between the groups. A significantly higher rate of complete mesorectal excision (92% vs. 72%; p = 0.001) and number of lymph nodes harvested (p = 0.009) was observed in the RAS group. There were no statistically significant differences between the groups regarding circumferential and distal resection margin involvement. The 3-year overall and disease-free survival rate was similar between the two groups (p = 0.849 and p = 0.582, respectively). Two patients in the LS group developed local recurrence and 27 patients (15.4%) developed metastatic disease. Multivariate analysis showed that tumor stage III was the only factor associated with disease-free survival (HR, 9.34; (95% CI 1.13-77.1), p = 0.038). RAS and LS showed similar outcomes in terms of perioperative, anatomopathological, and disease-free survival, after multiple surgeon implementations.

A study comparing split with loop transverse colostomies for defunctioning the left colon.

BACKGROUND: Loop transverse colostomy (LTC) is an established method for defunctioning the distal colon. We recently described an alternative method called split transverse colostomy (STC). METHODS: In this study we retrospectively compared the outcomes of LTC and STC in 49 patients with colorectal malignancy, pelvic tumours and diverticular disease. RESULTS: Patients were assigned without randomisation to undergo LTC (n=25) or STC (n=24). The two groups were similar in terms of age, gender and diagnosis. Postoperative complications were observed in 52.0% of patients in LTC group and in 16.7% of patients in STC group (p<0.05). The most common complication in both groups was stomal prolapse (n=2 and n=10, respectively). There were no intra-operative deaths. CONCLUSIONS: STC is safe, effective and associated with a lower incidence of stomal complications compared with the established procedure for defunctioning the distal colon. We propose that STC should be used to defunction the left colon in locally advanced disease (whether benign or malignant) where closure of the stoma is not envisaged.