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Background <p>Few studies have directly compared the incidence of primary postoperative ileus (primary POI) between robotic surgery (RS) and laparoscopic surgery (LS) for rectal resection.</p> Methods <p>This retrospective cohort study included patients who underwent elective rectal cancer resection at our institution between April 2021 and November 2025. After propensity score matching, the incidence of primary POI was compared between group RS and group LS. Multivariate logistic regression analysis was performed to identify risk factors. Primary POI was defined, according to an international consensus, as intestinal dysfunction persisting beyond postoperative day 4 in the absence of any apparent postoperative complications inducing POI.</p> Results <p>A total of 142 patients were analyzed with 71 patients in each group. Primary POI occurred in 16.9% of patients and was significantly more frequent in group RS than in group LS (25.4% vs. 8.5%, <i>p</i> = 0.007). The incidence of complications exceeding Clavien-Dindo grade III did not differ significantly&#xa0;between groups. Group RS had a significantly higher body weight-adjusted intraoperative fluid balance (median, 36.0 vs. 29.2&#xa0;mL/kg, <i>p</i> = 0.0025) and longer anesthesia time (median, 403 vs. 346&#xa0;min, <i>p</i> &lt; 0.001). Multivariate analysis identified advanced age (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.03–1.16; <i>p</i> = 0.0035), male sex (OR 6.83, 95%CI 1.65–28.2; <i>p</i> = 0.00798), body weight-adjusted intraoperative fluid balance (OR 1.04, 95%CI 1.00–1.08; <i>p</i> = 0.042) as risk factors for primary POI. Maintaining an anesthesia time &lt; 432&#xa0;min and body weight-adjusted intraoperative fluid balance &lt; 35.97&#xa0;mL/kg may reduce the incidence of primary POI.</p> Conclusion <p>The higher incidence of primary POI in robotic rectal surgery may be a surrogate marker for prolonged anesthesia time and increased intraoperative fluid balance. Fluid management and optimizing anesthesia time with shortening operative and setup durations may be essential to reduce the incidence of primary POI.</p>

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Robotic versus laparoscopic rectal resection: impact on primary postoperative ileus and the role of intraoperative fluid balance: a propensity score-matched cohort study

  • 期刊论文

  • 发表日期：

    2026年6月15日

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  • Tetsuhiro Urashima,
  • Taichi Yabuno,
  • Kota Imanishi,
  • Sachika Kinoshita,
  • Shogo Takei,
  • Yasuhiro Shimizu,
  • Yusaku Tanaka,
  • Yasuhisa Mochizuki

摘要

Background

Few studies have directly compared the incidence of primary postoperative ileus (primary POI) between robotic surgery (RS) and laparoscopic surgery (LS) for rectal resection.

Methods

This retrospective cohort study included patients who underwent elective rectal cancer resection at our institution between April 2021 and November 2025. After propensity score matching, the incidence of primary POI was compared between group RS and group LS. Multivariate logistic regression analysis was performed to identify risk factors. Primary POI was defined, according to an international consensus, as intestinal dysfunction persisting beyond postoperative day 4 in the absence of any apparent postoperative complications inducing POI.

Results

A total of 142 patients were analyzed with 71 patients in each group. Primary POI occurred in 16.9% of patients and was significantly more frequent in group RS than in group LS (25.4% vs. 8.5%, p = 0.007). The incidence of complications exceeding Clavien-Dindo grade III did not differ significantly between groups. Group RS had a significantly higher body weight-adjusted intraoperative fluid balance (median, 36.0 vs. 29.2 mL/kg, p = 0.0025) and longer anesthesia time (median, 403 vs. 346 min, p < 0.001). Multivariate analysis identified advanced age (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.03–1.16; p = 0.0035), male sex (OR 6.83, 95%CI 1.65–28.2; p = 0.00798), body weight-adjusted intraoperative fluid balance (OR 1.04, 95%CI 1.00–1.08; p = 0.042) as risk factors for primary POI. Maintaining an anesthesia time < 432 min and body weight-adjusted intraoperative fluid balance < 35.97 mL/kg may reduce the incidence of primary POI.

Conclusion

The higher incidence of primary POI in robotic rectal surgery may be a surrogate marker for prolonged anesthesia time and increased intraoperative fluid balance. Fluid management and optimizing anesthesia time with shortening operative and setup durations may be essential to reduce the incidence of primary POI.