Functional, oncologic and clinical outcomes of robotic rectal resection using the Hugo™ RAS system versus laparoscopic surgery: A comparative cohort study

BACKGROUND: To evaluate the functional, short-term oncologic and clinical outcomes of robotic rectal resection using the Hugo™ RAS (Robotic-assisted surgery) system compared with those of conventional laparoscopic surgery. METHODS: This retrospective cohort study was based on a prospectively maintained database. Baseline demographics, perioperative variables, postoperative complications (Clavien‒Dindo), and both functional (LARS score, pain, urinary and sexual function) and oncologic outcomes were compared. Functional outcomes were assessed at one, three and six months postoperatively. RESULTS: A total of 40 consecutive patients with rectal cancer who underwent surgery were included. 25 patients underwent laparoscopic resections and the remaining 15 patients received robotic resections using the Hugo™ RAS system. Baseline characteristics were comparable between the groups. At the six-month follow-up compared to the laparoscopic group, the robotic group had significantly lower mean LARS scores (19.2 vs. 9.8; p = 0.008), a greater proportion without LARS (53% vs. 85%; p = ns), and lower pain levels (not significant pain: 71% vs. 93%; p = 0.019). Male patients who underwent robotic surgery had significantly better sexual function at 6 months (p = 0.045). No statistically significant differences were found in terms of complications, but differences in anastomotic leakage (12% vs. 0%), paralytic ileus (16% vs. 6.7%) or Clavien‒Dindo 3-5 (24% vs. 13.4%) were clinically significant in favour of the robotic group. CONCLUSION: Robotic surgery with the Hugo™ RAS system is a feasible and safe alternative to conventional laparoscopic resection for rectal cancer, achieving comparable short-term oncologic outcomes while providing improved functional recovery. Ethics Committee of the General University Hospital of Elche (PI 60/2024). CLINICALTRIALS ID: NCT06512480.