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Background and objective: This study aimed to evaluate the long-term oncologic outcomes of robotic-assisted versus laparoscopic surgery in non-metastatic patients with locally advanced rectal cancer and to identify prognostic factors influencing overall survival (OS) and disease-free survival (DFS).

Method: In this retrospective cohort study, 74 patients with mid or low rectal cancer underwent either laparoscopic (Gr.1) (n = 28) or robotic-assisted (Gr.2) (n = 46) surgery over 10 years. Baseline characteristics, surgical details, postoperative complications, and survival outcomes were analyzed. Multivariate Cox regression was used to identify independent predictors of OS and DFS.

Result: Both groups had no significant difference in hospital stay, conversion rates, or postoperative complications. Multivariate analysis revealed that robotic surgery was independently associated with improved OS (HR 2.651; p = 0.019). Other significant predictors of poor OS included tumor grade G3, perineural invasion, and postoperative complications. For DFS, perineural invasion, postoperative complications, conversion to open surgery, and tumor recurrence were associated with worse outcomes. Restoration of bowel continuity via End-to-End Anastomosis was linked to improved survival.

Summary: Robotic-assisted surgery offers comparable, and in some aspects superior, long-term oncologic outcomes to laparoscopic surgery for locally advanced rectal cancer. Independent predictors of poor survival included high-grade tumors, perineural invasion, conversion to open surgery, and postoperative complications. Surgical technique, selection criteria, and perioperative care remain crucial for optimizing outcomes.