EP 770 Robotic versus Laparoscopic Total Mesorectal Excision: A Single-Centre Propensity-Matched Analysis
Mohammed Arifuzaman, Madan Jha, Vikram GarudAbstract
Background
Robotic total mesorectal excision (TME) is increasingly used for rectal cancer because of its perceived advantages in the confined pelvis. However, its peri-operative benefit over conventional laparoscopy remains debated. This study compared robotic and laparoscopic TME performed at a UK tertiary colorectal unit.
Methods
A retrospective review was conducted of all oncological TMEs (low anterior resections and abdominoperineal excisions) performed between September 2023 and February 2025. Benign and non-resectional procedures were excluded. Primary outcomes were operating time and theatre time; secondary outcomes included length of stay (LOS), complications, and 30-day readmission. Propensity-score matching (1:1, caliper 0.1 SD) was attempted using age, BMI, ASA grade, Charlson Comorbidity Index, and gender. Paired continuous variables were compared using the Wilcoxon signed-rank test; binary variables using exact McNemar testing.
Results
A total of 36 robotic and 3 laparoscopic TMEs were identified. Due to the very small laparoscopic cohort, only one matched pair could be generated. Within this pair, operating time was 370 min (robotic) vs 183 min (laparoscopic), and theatre time was 426 min vs 250 min, with no statistically significant differences. Both patients experienced postoperative complications and required readmission. No meaningful inference could be drawn regarding clinical superiority.
Conclusions
At this centre, robotic-TME constituted the overwhelming majority of rectal-resections, limiting the ability to perform robust comparative analysis. Based on the matched-pair available, no-demonstrable peri-operative advantage of robotics was observed. Larger-multicentre datasets are required to evaluate potential benefits in pelvic dissection, functional outcomes, and cost-effectiveness.