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CC BY 4.0 · Journal of Coloproctology 2025; 45(04): s00451812076
DOI: 10.1055/s-0045-1812076
Original Article

Robotic Versus Laparoscopic Total Mesorectal Excision for Middle Rectal Cancer: Functional Results from a Randomized Pilot Study

Authors

  • Marcus Valadão 

    1   Department of Abdominopelvic Surgery, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil

  • Rodrigo Araújo

    1   Department of Abdominopelvic Surgery, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil

  • João Antônio Pereira-Correia

    2   Department of Urology, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil

  • Valter José Fernandes Muller

    2   Department of Urology, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil

  • Eduardo Linhares

    1   Department of Abdominopelvic Surgery, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil

  • Carlos Véo

    3   Department of Colorectal Cancer Surgery, Hospital de Amor, Barretos, SP, Brazil

  • Marcos Denadai

    3   Department of Colorectal Cancer Surgery, Hospital de Amor, Barretos, SP, Brazil

  • Felipe Daldegan

    3   Department of Colorectal Cancer Surgery, Hospital de Amor, Barretos, SP, Brazil

  • Luis Romagnolo

    3   Department of Colorectal Cancer Surgery, Hospital de Amor, Barretos, SP, Brazil

Funding The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.
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Abstract

Introduction

Urinary and sexual dysfunctions are recognized as serious complications that affect patients' quality of life after mid-rectal cancer surgery; however, studies that focus on the urogenital function after robot-assisted compared to laparoscopic rectal cancer surgery are limited.

Objective

To compare functional outcomes between patients undergoing robotic and laparoscopic approaches for middle rectal cancer submitted to neoadjuvant chemoradiation.

Materials and Methods

Patients with mid-rectal cancer were prospectively enrolled in this phase-II randomized trial to robotic or laparoscopic total mesorectal excision (TME). After eligibility was confirmed and chemoradiation therapy was completed, patients underwent randomization in a 2:1 ratio (robotic: laparoscopic TME groups) with stratification according to gender (male or female) and body mass index (BMI) < 35 or ≥ 35. The assessment of urinary function was carried out using complete urodynamic study, urinary symptoms questionnaire (International Consultation on Incontinence Questionnaire – Short Form [ICIQ-SF]), and urinary continence questionnaire (International Prostate Symptom Score [I-PSS]). The complete urodynamic study and the questionnaires were carried out before the start of any treatment and after neoadjuvant therapy (before surgery) and was repeated in the 1st, 3rd, 6th, 12th, 18th and 24th postoperative months. The analysis of male sexual function was carried out using International Index of Erectile Function (IIEF-5) questionnaire. Female sexual function was analyzed using the specific Female Sexual Functiona Index (FSFI) questionnaire, and the Quality-of-Life Questionnaire Core 30 (QLQ-C30) and Quality-of-Life Questionnaire - Colorectal Cancer 29 (QLQ-CR29 were applied to patients at the same time as the sexual and urinary function assessment questionnaires.

Results

Between 2017 and 2022, 32 patients entered the trial, and 30 were eligible to participate (2 patients were excluded due to screening failure). Among them, only 21 were randomized to robotic or laparoscopic group. Only 9 (42.9%) and 12 patients (57.1%) underwent urodynamic testing at the 3rd and 6th month of postoperative follow-up, respectively. Eighteen (85.7%) and 16 patients (76.2%) completed both the ICIQ-SF and I-PSS questionnaires at the 3rd and 6th month of postoperative follow-up, respectively. Only 7 and 10 patients (33.3% and 47.6%, respectively) completed the IIEF-5 and FSFI at the 3rd month of postoperative follow-up. There was no significant difference in age, BMI, tumor location, neoadjuvant therapy, postoperative pathological results, and adjuvant therapy between the two groups. Our study did not identify any parameter that could suggest lower urinary tract dysfunction in both groups analyzed, either by evaluating maximum flow, postvoid residue and, mainly, by the results of detrusor pressure at maximum flow. On the other hand, the present study demonstrated better sexual function outcomes with robotic surgery in male patients as assessed by the IIEF-5 score. There was a slight advantage to robotic surgery at the 3-month follow-up (median score 18 for robotic versus 17 for laparoscopic). By 6 months, the difference became more pronounced in favor of the robotic group (median score 23 for robotic versus 15 for laparoscopic). Additionally, there was better sexual desire at 3 months in the robotic group according to the QLQ-C29 (median score 66.7 in the robotic group versus 16.6 in the laparoscopic group).

Conclusion

The robotic approach for TME was associated with potentially better male sexual function than the laparoscopic approach. More randomized studies with a larger number of patients are necessary to confirm our findings.

Keywords

robotic surgery - laparoscopic - rectal cancer - urogenital function

Authors' Contributions

MV: Conceptualization; Methodology; Investigation; Supervision; Writing – Original Draft; Writing – Review & Editing; RA: Data Curation; Formal Analysis; Investigation; Writing – Review & Editing; JAPC: Methodology; Resources; Investigation; Writing – Review & Editing; VJFM: Data Curation; Formal Analysis; Visualization; Writing – Review & Editing; EL: Resources; Investigation; Validation; Writing – Review & Editing; CV: Methodology; Resources; Investigation; Writing – Review & Editing; MD: Interpretation of Data; Writing – Review & Editing; FD: Resources; Data Curation; Visualization; Writing – Review & Editing; LR: Validation; Writing – Review & Editing.




Publication History

Received: 02 November 2024

Accepted: 04 August 2025

Article published online:
29 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Marcus Valadão, Rodrigo Araújo, João Antônio Pereira-Correia, Valter José Fernandes Muller, Eduardo Linhares, Carlos Véo, Marcos Denadai, Felipe Daldegan, Luis Romagnolo. Robotic Versus Laparoscopic Total Mesorectal Excision for Middle Rectal Cancer: Functional Results from a Randomized Pilot Study. Journal of Coloproctology 2025; 45: s00451812076.
DOI: 10.1055/s-0045-1812076