Oncological outcomes of robotic versus laparoscopic colectomy for colon cancer: a propensity score–matched study focusing on peritoneal recurrence

Abstract

Purpose: To compare perioperative and oncologic outcomes between robotic and laparoscopic colectomy for colon cancer, with a focus on peritoneal recurrence, using a propensity score–matched analysis. Methods: We retrospectively reviewed 591 patients who underwent minimally invasive colectomy for colon cancer between 2016 and 2024. After 1:1 propensity score matching based on age, sex, body mass index, American Society of Anesthesiologists physical status, clinical stage, and procedure, 90 patients in each group were analyzed. Survival outcomes were assessed using Kaplan-Meier methods and competing risk analysis with the Fine-Gray model. Results: Robotic colectomy showed lower blood loss (median, 10 mL vs. 20 mL; P<0.001), shorter postoperative hospital stay (median, 9 days vs. 11.5 days, P<0.001), and a higher rate of intracorporeal anastomosis (92.2% vs. 24.4%, P<0.001), without prolonging operative time. Disease-free survival was comparable (P=0.519). Locoregional/peritoneal recurrence-free survival was higher in the robotic group (P=0.037); however, competing risk analysis using the Fine-Gray model showed no significant difference in the cumulative incidence of locoregional/peritoneal recurrence between groups. Multivariable analysis identified high-grade histology as an independent predictor of peritoneal recurrence, whereas surgical approach was not. Conclusion: Robotic colectomy provides favorable perioperative outcomes while maintaining oncologic safety comparable to laparoscopic colectomy. Peritoneal recurrence appears to be driven primarily by tumor biology, and intracorporeal anastomosis does not increase recurrence risk.