62 A Comparison Between Open, Laparoscopic and Robotic Resection of Rectal Cancer and Rates of Sub-Optimal Resection

Abstract Rectal cancer comprises approximately 27% of bowel cancers in the UK. Surgical treatment is via rectal resection (RR) with certain criteria in lymph node yield, resection plane and distance to margins. We compared RR outcomes between open (OS), laparoscopic (LS) and robotic surgery (RS). Between January 2017 and January 2024, we enrolled patients who underwent RR for tumours at 15 cm or below from the anal verge (AV). We compared clinicopathological variables and analysed factors associated with sub-optimal resection (SR). We defined SR as a circumferential resection margin of ≤1mm, lymph node yield of <12, positive resection margins, sub-mesorectal plane of dissection, and distance to longitudinal margins of ≤2cms. A total of 222 patients were analysed, with 70.7% receiving LS, 10.4% OS and 18.9% RS. Operative time did not differ significantly, however the length of stay was longer in the OS group, compared to the LS and RS groups (mean 12.48 vs 8.32 vs 9.00 days respectively, P=0.011). Factors associated with sub-optimal resection included operative time exceeding 6 hours (P=0.001), and receiving preoperative chemo-radiotherapy (PCRT) (P=0.014). The method of RR did not affect the resection quality, nor did the age, body mass index, tumour size or height. Our data suggests LS and RS reduces the length of stay compared to OS. SR occurred more frequently in patients who had longer operations or PCRT. The type of RR did not affect the resection quality.