SP3.1 - Could shorter length of stay and oncological non inferiority justify a radical paradigm shift towards RAS to be the gold standard for all rectal cancer resections

Abstract Aim Robotic-assisted surgery (RAS) has proven to be an effective alternative to open (OP) and laparoscopic-assisted (LAP) rectal cancer resections. We aim to evaluate pathological and peri-operative outcomes of patients in a single centre undergoing rectal cancer resections using all three surgical techniques to evaluate whether RAS should be the gold-standard. Methods We retrospectively identified all elective rectal cancer resection cases since 2019 at our centre offering OP, LAP, and RAS services. We audited length-of-stay (LoS), complications, readmission rates, margin clearance status, and lymph node yield. Results Since 2019, there were 28 OP, 77 LAP, and 35 RAS resections performed. The median LoS for OP resections was 11 days, for LAP was 8 days (p=0.02) and was lowest for RAS resections (3 days, p=0.005). Readmission rates were highest for OP resections (21.4%) and were identical for LAP and RAS resections (14.2% each). Complications (OP 25%, LAP 34%, RAS 37%; p>0.05) were categorized using Clavien-Dindo (CD) classification with LAP having highest proportions of CD-IV (7.7%) and CD-V (7.7%), whereas RAS and OP resections had no severe complications (CD-IVa/IVb/V). Conclusion Our analysis shows significantly superior outcomes for shorter LoS and clear non-inferiority of RAS in all other aspects as compared to conventional approaches. Efforts must be bolstered to introduce RAS for rectal cancer resections in the long run considering the need for increasing training opportunities and improved resources to allow for a stable transition to RAS led services, rather than a radical conversion. Further studies are warranted to substantiate our observation.