© 2016 Wichtg Publishing TJ ISSN 0300-8916 Tumori 2016; 102(4): 414-421 ORIGINAL RESEARCH ARTICLE for laparoscopic colorectal surgery. Several comparatve stud- ies show that laparoscopic colorectal surgery ofers beter short-term outcomes, such as smaller incisions, reducton in postoperatve pain and duraton of postoperatve ileus, and shorter hospital stay with comparable oncologic results (1-5). Regarding colorectal cancer, multple randomized trials have demonstrated equivalent oncologic outcomes when compar- ing the open surgical approach to laparoscopy (6-8). Howev- er, doubts remain respectng the applicability of laparoscopy concerning the realizaton of optmal dissecton with com- plete mesorectal excision and rectal transecton, because of the assistant-dependent unstable 2D view, the tremor, the fulcrum efect at the port site, and the poor ergonomics and limited dexterity of surgical instruments (9, 10). The techno- logical advancements in robotc assisted surgical techniques DOI: 10.5301/tj.5000533 Open, laparoscopic, and robotc surgery for rectal cancer: medium-term comparatve outcomes from a multcenter study Carlo Corbellini 1,2 , Roberto Bif 1 , Fabrizio Luca 1 , Antonio Chiappa 1,2 , Stefano Costa 3 , Emilio Bertani 4 , Stefano Bona 5 , Davide Lombardi 6 , Darina Tamayo 7 , Edoardo Boteri 8 , Bruno Andreoni 2,9 1 Division of Digestve Surgery, European Insttute of Oncology, Milan - Italy 2 General Surgery Residency, School of Medicine, University of Milan, Milan - Italy 3 General and Emergency Surgery Department, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan - Italy 4 Hepatobilary and Pancreatc Surgery Division, European Insttute of Oncology, Milan - Italy 5 General and Digestve Surgery Department, Humanitas Cancer Centre Rozzano, Milan - Italy 6 Division of General Surgery, Ospedale Girolamo Fracastoro, San Bonifacio, Verona - Italy 7 Division of Endoscopy, European Insttute of Oncology, Milan - Italy 8 Division of Epidemiology and Biostatstcs, European Insttute of Oncology, Milan - Italy 9 Palliatve Care Department, European Insttute of Oncology, Milan - Italy Introducton Laparoscopic techniques have been considerably devel- oped within the feld of general surgery, especially techniques ABSTRACT Purpose: Several studies have demonstrated the oncologic equivalence of laparoscopic (LS) and open (OS) rectal cancer surgeries and have shown how challenging LS may become. Robotc surgery (RS) has emerged as a pract- cal alternatve, ofering interestng advantages in comparison to both LS and OS. The aim of this study is to resolve the clinicopathologic outcome advantages of RS with respect to OS and LS techniques. Methods: Patents with rectal cancer undergoing OS, RS, or LS were evaluated within the period from April 2009 to August 2011. The evaluatons were carried out in 4 Italian hospitals. Perioperatve clinicopathologic data, post- operatve complicatons, and 3-year overall and disease-free survival (DFS) rates were analyzed. Results: A total of 160 patents (94 male, 66 female) were included. A total of 105 patents underwent mini- invasive procedure (40 LS; 65 RS), whereas OS was performed in 55 patents. Anterior resecton of rectal cancer was the most performed surgical procedure (139; 87%). Median operaton tme was signifcantly longer in the RS group (p<0.01). Regarding complicaton rates and quality of the surgical specimen evaluaton, no statstcal difer- ence was found among the 3 groups. The shortest hospital stay (p<0.01) was obtained from the LS and RS groups. The median follow-up was 33 months without any signifcant diference in overall and DFS rates. Conclusions: Although RS for rectal cancer requires more tme to be performed than LS and OS techniques, the analysis shows comparatvely the feasibility and safety of RS in terms of perioperatve clinicopathologic and medium-term outcomes. Keywords: Laparoscopic surgery, Medium-term outcome, Open surgery, Rectal cancer, Rectal cancer resecton, Robotc surgery Accepted: May 25, 2016 Published online: July 2, 2016 Corresponding author: Carlo Corbellini, MD Department of General Surgery European Insttute of Oncology Via Giuseppe Ripamont, 435 20141 Milan, Italy carlo.corbellini@yahoo.it