Robotic rectal cancer surgery in a medium-volume center: Oncologic and functional outcomes of an 8-year experience

Background: Rectal cancer is one of the most technically challenging malignancies to manage because of the confined pelvic space and the need to achieve oncologic radicality while preserving urinary and bowel function. Robotic technology represents a major advancement in minimally invasive colorectal surgery, offering improved dexterity, three-dimensional vision, and greater precision in dissection. This study evaluated the oncologic safety and postoperative functional outcomes of robotic rectal cancer surgery performed at a medium-volume tertiary institution. Methods: Between October 2017 and April 2025, 80 consecutive patients with biopsy-confirmed rectal adenocarcinoma underwent robotic resection using the da Vinci Si or Xi systems. The inclusion criteria were a tumor distance ≤ 15 cm from the anal verge and an indication for total mesorectal excision (TME). Perioperative variables, oncologic parameters (R0 rate, margin status, and lymph node yield), and postoperative recovery data were prospectively collected. Bowel, urinary, and sexual functions were evaluated using validated questionnaires (LARS, IPSS, IIEF/FSFI, and SF-36) administered pre-treatment and at 1, 6, and 12 months postoperatively. Results: Anterior resection with TME was the predominant procedure (78.8%). R0 resection was achieved in 98.8% of patients, with no positive circumferential margins. A complete pathological response was observed in 18.8% of patients. Major complications (Clavien-Dindo ≥ III) occurred in 6.3% of patients, and anastomotic leakage in 7.5%. After a median follow-up of 41 months, overall survival was 82.5% at three years and 67.9% at five years. Functional recovery was satisfactory, with near-complete restoration of the preoperative quality-of-life scores at one year. Only one patient (1.2%) reported minor LARS. Conclusions: Robotic rectal resection provides safe, standardized, and oncologically sound outcomes with excellent postoperative function, even in medium-volume centers.