Abstract:

Objective

To compare the long-term treatment outcomes of robotic-assisted natural orifice specimen extraction surgery （NOSES） with laparoscopic-assisted surgery in patients with mild-tolow risk rectal cancer.

Methods

A retrospective analysis was conducted in 64 patients with middle to low rectal cancer who underwent NOSES treatment in the 940th Hospital of the Joint Logistic Support Force between June 2018 and June 2021. 20 cases （R-N group） received robotic assistance surgery， while 44 cases（L-N group） underwent laparoscopic-assisted surgery. The follow-up period extended until September 2022 and was conducted via phone or outpatient visits. The study compared basic demographics， intraoperative conditions， postoperative complications， and three-year disease-free survival （DFS） and overall survival （OS）between the two groups.

Results

The R-N group had significantly higher hospitalization costs and longer operation time compared to the L-N group （P＜0.001）. However， intraoperative blood loss was significantly less in the R-N group （P=0.001）. Additionally， the R-N group experienced shorter first postoperative flatus time （P=0.016） and lower usage of postoperative analgesics， including parecoxib sodium （P=0.002）. There were no significant differences in postoperative complications and pathological outcomes between the two groups. The three-year OS （90.0% vs 90.9%， P=0.707） and DFS （80.0% vs 86.4%， P=0.892） were similar between both groups.

Conclusion

Compared to laparoscopic-assisted surgery combined with NOSES for middle to low rectal cancer， robotic-assisted surgery combined with NOSES offers higher safety and efficacy，reduced intraoperative blood loss， fewer postoperative complications， and potentially better patient prognosis.

Key words: Rectal neoplasms, Middle and low, Natural orifice endoscopic surgery, Laparoscopy, Robotic surgical procedures