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among whom two patients had a pT4 tumor. In our study, postoperative positive CRM was not suspected
in the preoperative oncologic assessment for these patients. However, this high rate of positive CRM raises
the issue of preoperative patients’ selection. Upfront open APR could be chosen over RAAPR according to
parameters that take into account the specificities of the robotic approach.

Any proposal for the routine utilization of robotic assistance in surgery requires a proof of clinical benefit,
while considering the associated full set of costs. Indeed, even if MIRS has been shown to be associated
with lower morbidity rate, reduced pain, and early return to work, there are not enough data to state that
[14]
oncological results are equivalent . Added to the difficulty in proving its clinical benefits, the use of
robotic approach in APR outside clinical studies remains questionable.

DECLARATIONS
Authors’ contributions
Data acquisition, data analysis, manuscript drafting, manuscript revision: Abdalla S
Data acquisition, manuscript revision: Valverde A, Fléjou JF, Goasguen N, Oberlin O
Study design, data analysis, manuscript drafting, manuscript revision, final approval: Lupinacci RM

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
This study was conducted according to the ethical standards of the local institutional committee on human
experimentation and the consent form of all patients was obtained.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2019.

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