Perioperative Outcomes of Robotic Versus Conventional Laparoscopic Pelvic Exenteration for Anteriorly Invaded Primary Colorectal Cancer: A Retrospective Study

Background: Robot-assisted surgery has been widely adopted in digestive, urological, and gynecologic procedures, leading to its application in complex operations such as pelvic exenteration (PE). However, limited data are available regarding the perioperative outcomes of robotic PE compared directly to conventional laparoscopic PE in the treatment of colorectal cancer. Methods: To assess the feasibility of robotic PE compared with laparoscopic PE for locally advanced colorectal cancer invading the anterior pelvic organs, we retrospectively reviewed patients who underwent either robotic or laparoscopic PE with curative intent (R0 resection) between May 2012 and August 2024. Results: A total of 24 patients were included in the study (12 in the robotic group and 12 in the laparoscopic group). Patient characteristics revealed that the robotic group had an older median age and a lower prognostic nutritional index. In terms of surgical outcomes, no significant differences were observed in PE type, total operative time, estimated blood loss, or the number of retrieved lymph nodes. Conversion to open surgery occurred in 3 patients in the laparoscopic group, whereas no conversions were noted in the robotic group ( P = 0.032). The reasons for conversion in the laparoscopic group included uncontrollable bleeding and technical difficulty due to large tumor size. Conclusions: Robotic surgery may offer greater suitability for complex procedures such as PE, compared with conventional laparoscopic surgery, particularly in challenging cases involving large tumors.