Evaluating Surgical Options for Obese Rectal Cancer Patients: A Comparison of Open, Laparoscopic, and Robotic Surgery Short-Term Outcomes

Abstract The presence of obesity significantly complicates surgical procedures for patients suffering from rectal cancer, while also amplifying the risk of encountering severe postoperative complications. This research examines the short-term outcomes experienced by obese individuals with rectal cancer who underwent open, laparoscopic, and robotic surgical procedures, with the aim of providing insights into clinical decision-making. A retrospective analysis was performed on data gathered from 348 patients treated at Subei People's Hospital, spanning November 2019 to March 2024. The patients were categorized into three groups: those who underwent open surgery (OS, n = 107), laparoscopic surgery (LS, n = 185), and robotic surgery (RS, n = 56). The results show that although baseline characteristics and tumor efficacy were similar across groups, It is noteworthy that the RS group exhibited the longest operative time and incurred the highest inpatient costs, but it also manifested the minimal intraoperative blood loss and the shortest postoperative recovery period, encompassing first flatus time, first oral diet time, and hospital stay duration. This was followed by the LS group and subsequently the OS group, with statistically significant disparities evident among the three groups (P < 0.05). Compared to the OS group, both the LS and RS groups exhibited notably reduced rates of overall complication and wound infection (P < 0.05), while no substantial difference was observed between the LS and RS groups (P > 0.05). RS significantly outperformed both OS (P = 0.038) and LS (P = 0.046) in preventing urinary dysfunction. These findings suggest that RS, despite higher costs and longer operative times, offers significant advantages in recovery and complication rates, highlighting its potential as a preferred surgical option for obese rectal cancer patients. This study provides crucial evidence to guide surgical approach choices, underscoring the importance of weighing operative time and cost against patient recovery and complication outcomes.