Background: Our aim was to evaluate the impact of obesity on operative and long-term oncological outcomes following rectal cancer surgery. Methods: Single-center retrospective review of all patients that underwent rectal resection for primary rectal adenocarcinoma between 2010 and2020. Divided into two groups based on preoperative body mass index (BMI): obese—BMI ≥ 30 kg/m², non-obese—BMI < 30 kg/m². Results: Total of 513 patients included 100 in the obese group (mean BMI 33.5 kg/m², range 30–45.6) and 413 in the non-obese group (mean BMI 24.9 kg/m², range 15.6–29.9, p < 0.001). The groups exhibited a similar age distribution (63.94 and 63.23, p = 0.59) or gender distribution (p = 0.83) between the groups. The obese group had higher conversion rates to open approach (22% versus 11.6%, p = 0.007), and longer surgeries (median 300 min, versus 260 min, p = 0.003), but similar overall postoperative complications (73% versus 64.4%, p = 0.1), 30-day readmission (19% versus 17.4%, p = 0.71), harvested lymph nodes (16 versus 14, p = 0.38), incidence of positive resection margins, 5-year overall survival (94.2% versus 88.7%, p = 0.97), and 5-year disease-free survival (70.4% versus 72%, p = 0.59). Conclusions: Obesity did not affect immediate overall surgical outcomes, surgical pathology quality indexes or long-term oncological outcomes.

Background/objectives: To analyze risk factors for prolonged operative time (OT) in patients undergoing rectal cancer surgery, and to explore the effects of prolonged OT on immediate surgical outcomes and long-term oncological outcomes. Methods: A single-center retrospective review of all patients who underwent an elective rectal resection for primary rectal adenocarcinoma between 2010 and 2020. OT was standardized according to surgeon-specific and surgical approach-specific median values. Subsequently, the cohort was divided according to surgery duration: The Short OT group (244 patients; median OT 201 min, range 46–600) and the Long OT group (250 patients; median OT 340 min, range 145–960). Results: Multivariate analysis identified independent predictors for prolonged surgery: higher BMI (AOR 1.07, p = 0.002) and distance from anal verge (AOR 0.89, p < 0.001). Intraoperative complications occurred more frequently in the Long OT group (21.6% vs. 10.2%, p < 0.001), as did overall post-operative morbidity (73.2% vs. 60.7%, p = 0.003). The 5-year OS rates were comparable between groups (88.8% vs. 90.8%, p = 0.14); however, 5-year RFS was significantly worse in the Long OT group (65.5% vs. 78.2%, p = 0.004). Multivariable Cox regression using surgeon–approach standardized time quartiles showed reduced recurrence-free survival per one-quartile duration increase (HR 1.37, 95% CI 1.12–1.69, p = 0.002). Conclusions: Higher BMI and lower tumor location were found to be independent preoperative predictors of prolonged rectal cancer surgery. Prolonged operative time was associated with higher perioperative morbidity and poorer long-term recurrence-free survival.