Treatment outcomes of robot-assisted rectal cancer surgery with multivisceral resection of adjacent organs.

Robotic surgery is increasingly adopted for rectal cancer management, including selected patients with locally advanced disease. We evaluated perioperative safety and medium- to long-term outcomes after robot-assisted rectal cancer surgery with multivisceral resection for cT4 rectal cancer in a single high-volume center. We retrospectively reviewed 45 consecutive patients with locally advanced rectal cancer who underwent robot-assisted surgery with multivisceral resection between April 2021 and June 2025. Demographic and clinical variables, surgical and postoperative outcomes, and pathological findings were extracted from medical records. Recurrence-free survival (RFS), overall survival, and local recurrence were assessed. The study included 45 patients (19 females) with a median age of 72 years. Postoperative complications of Clavien-Dindo grade III or higher occurred in 4 patients (8.8%). Pathologically, 21 patients (46.7%) had pT4 disease (pT4a in 2 and pT4b in 19 [42.2%]), and 39 patients (86.7%) achieved RM0 margins. The median follow-up was 23 months. Across stages I-III, RM0 resection was associated with superior 3-year RFS compared with RM1/RMX resection (74.6% vs. 33.3%, p = 0.03). Robot-assisted rectal cancer surgery combined with multivisceral resection can be performed safely, with acceptable midterm outcomes. RM0 status was linked to improved RFS, supporting complete tumor resection as a prognostic determinant even in locally advanced cases.