Minimally Invasive Lower Anterior Resections - Better Than Open But Not All The Same

Purpose: The optimal approach for lower anterior resection (LAR) has been closely debated. The relatively new addition of the robotic approach adds a layer of complexity to this topic. The majority of the literature has compared the possible approaches 2 at a time; however, only a few studies have comprehensively compared all 3 approaches at the same time. Methods: This is a retrospective cohort study of a prospectively maintained database at a non-university tertiary care center. A total of 130 patients underwent open, laparoscopic, or robotic oncological lower anterior resection from 2014 to January 2020. Results: Statistical significance of length of stay (LOS) was noted between the three approaches (p< 0.005) with the mean LOS for open being 8.08 days, laparoscopic being 7.04 day, and robotic being 4.96 days. No statistical significance was noted for estimated blood loss, operating time, or postoperative complications including anastomotic leak, ileus, pneumonia, pulmonary embolism, surgical site infection, and urinary tract infection. Conclusions: No one particular LAR approach demonstrates superiority in regards to perioperative outcome. Post-operatively, robotic LAR has a shorter LOS and appears to be a safe alternative to open and laparoscopic LARs, further bolstering the advocacy of robotic LAR over its counterparts.