Background There is a lack of information regarding the oncological safety of robotic intersphincteric resection (ISR) with coloanal anastomosis. The objective of this study was to compare the long-term feasibility of robotic compared with laparoscopic ISR. Methods Between January 2008 and May 2011, consecutive patients who underwent robotic or laparoscopic ISR with coloanal anastomosis from seven institutions were included. Propensity score analyses were performed to compare outcomes for groups in a 1 : 1 case-matched cohort. The primary endpoint was 3-year disease-free survival. Results A total of 334 patients underwent ISR with coloanal anastomosis, of whom 212 matched patients (106 in each group) formed the cohort for analysis. The overall rate of conversion to open surgery was 0·9 per cent in the robotic ISR group and 1·9 per cent in the laparoscopic ISR group. Nine patients (8·5 per cent) in the laparoscopic group and three (2·8 per cent) in the robotic ISR group still had a stoma at last follow-up (P = 0·075). Total mean hospital costs were significantly higher for robotic ISR (€12 757 versus €9223 for laparoscopic ISR; P = 0·037). Overall 3-year local recurrence rates were similar in the two groups (6·7 per cent for robotic and 5·7 per cent for laparoscopic resection; P = 0·935). The combined 3-year disease-free survival rates were 89·6 (95 per cent c.i. 84·1 to 95·9) and 90·5 (85·4 to 96·6) per cent respectively (P = 0·298). Conclusion Robotic ISR with coloanal anastomosis for rectal cancer has reasonable oncological outcomes, but is currently too expensive with no short-term advantages.
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