Short-term outcomes and feasibility of robotic-assisted surgery for pT4 colorectal cancer: A multicenter retrospective study

Purpose To evaluate the surgical and oncological outcomes of robotic surgery for pT4 colorectal cancer compared with laparoscopic and open approaches. Methods This multicenter retrospective study included 494 patients undergoing curative resection for pT4 colorectal cancer (2016–2025). Patients were categorized into robotic (R; n = 32), laparoscopic (L; n = 385), and open (O; n = 77) groups. Short-term outcomes and recurrence-free survival (RFS) were assessed. To determine independent predictors of postoperative complications, we applied multivariable logistic regression models (Trial registration: UMIN000059581). Results The R group achieved the lowest median blood loss (20 vs 26 vs 197 mL; p < 0.001) and zero conversions, despite longer operative times (278 vs 250 vs 212 min; p = 0.003). Complication rates (Clavien-Dindo ≥ II) were comparable among the groups (28.1%, 22.6%, and 28.6%; p = 0.45). In multivariable analysis, surgical approach was not associated with postoperative complications (Robotic vs Laparoscopic: OR 1.02, 95% CI 0.41–2.40; p = 0.960). Regarding oncological outcomes, 3-year RFS showed similar trends across the three groups (log-rank p = 0.86). Conclusion(s): Robotic surgery for pT4 colorectal cancer resulted in minimal blood loss and zero conversions. The procedure demonstrated perioperative safety and feasibility comparable to laparoscopic surgery. In oncology, 3-year RFS showed similar trends, although long-term confirmation is required. Trial registration number: UMIN000059581, date of registration: October 29, 2025, retrospectively registered.