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Table 1. Laparoscopic surgery for rectal cancer
Ref. Study type Randomization Group Sample size Follow up Questionnaires Main findings Level of
studied evidence
Breukink et al. [20] , Prospective No Lap LAR 51 (38 Lap 12 months SF-36, EORTC -LAR had better sexual 2b
2007 single center vs. Lap LAR, 13 Lap QLQ-C30, QLQ- function, body image,
APR APR) CR38 and overall QOL
- LAR had less fatigue,
pain, appetite loss,
and diarrhea at 12
months compared to
baseline
Braga et al. , Prospective Yes (1:1) Lap vs. 168 (83 Lap, 12 months SF-36 -Lap had better overall 1
[21]
2007 single center Open 85 Open) QOL at 12 months
TME compared to open
George et al. [22] , Prospective No Lap 34 12 months IPSS, IIEF -Urinary dysfunction 2b
2018 single center TME in in 20% at 3 months to
male 3% at 9 months
patients - Sexual dysfunction
in 75% at 3 months to
42% at 12 months
Jayne et al. [4,23] , Prospective Yes (2:1) Lap vs. 347 (526 Lap, 36 months EORTC QLQ-C30, -Lap had worse sexual 1
2007 (CLASICC) multicenter Open 268 Open) QLQ-CR38 function at 3 months
TME but no difference at 6
months to 36 months
compared to open
-Lap had worse social
function at 36 months
compared to open
Jeong et al. [24] , Prospective Yes (1:1) Lap vs. 340 (170 Lap, 36 months EORTC QLQ-C30, -No difference in over- 1
2014 (COREAN) multicenter Open 170 Open) QLQ-CR38 all QOL at 36 months
TME
mid to
low
Andersson et al. [25,26] , Prospective, Yes (2:1) Lap vs. 385 (260 Lap, 24 months EORTC QLQ- -No difference in over- 1
2014 (COLOR II) multicenter Open 125 Open) CR38 all QOL at 24 months
TME
Fleshman et al. [27] , Prospective Yes (1:1) Lap vs. 462 (240 Lap, - - -Pending 1
2015 (ACOSOG multicenter Open 222 Open)
Z6051) TME
Stevenson et al. [28] , Prospective, Yes (1:1) Lap vs. 475 (238 Lap, - - -Pending 1
2015 (ALaCaRT) multicenter Open 237 Open)
TME
Lap: laparoscopic; TME: total mesorectal excision; LAR: low anterior resection; APR: abdominoperineal resection; QOL: quality of life;
SF-36: short form general health survey of 36 questions; EORTC QLQ-C30: European organization for research and treatment of cancer
quality of life questionnaire, 30 cancer non-specific questions; EORTC QLQ-CR38: European organization for research and treatment
of cancer quality of life questionnaire, 38 colorectal cancer specific questions; IPSS: International Prostatic Symptom Score; IIEF:
International Index of Erectile Function; Level of evidence: 1: randomized controlled trial; 2a: randomized prospective cohort study; 2b:
nonrandomized prospective cohort study; 3: retrospective cohort study; 4: case series

scores) than the laparoscopic group at 6 months in males. Furthermore, the male patients in the robotic
group demonstrated a return to baseline in urinary symptoms at 12 months that was not achieved in the
laparoscopic group. There were no significant differences found in female patients between groups com-
pared to baseline. Sexual function returned to baseline at 6 months in the robotic group, but did not re-
turn to baseline until 12 months after surgery in the laparoscopic group. Overall, this study showed that
although quality of life worsens initially after surgery, the robotic group had an earlier return to baseline
quality of life than the laparoscopic group .
[35]
Another large single center study compared open (n = 114) vs. robot-assisted (n = 108) intersphincteric resections
and found that at 6 and 12 months post operatively, robotic-assisted surgeries resulted in improved fecal
incontinence scores (12.5 and 7.7 in the robotic group, and 14.2 and 10.3 in the open group, P < 0.001) . At
[36]
6 months post-operatively, severe sexual dysfunction occurred 2.7 times more in the open group than the
robotic-assisted group (34.1% vs. 12.5%; P = 0.023) in male patients over the age of 65. Specifically, erectile
[36]
dysfunction was more common in the open group than the robotic group (31.8% vs. 12.5%, P = 0.04) .