Background/Objectives: Postoperative paralytic ileus (POI) is a common complication after rectal resections. Although it is often argued that laparoscopic or robotic surgery reduces ileus compared to open surgery, research indicates that the incidence rates remain considerably high after minimally invasive surgery (MIS), and it is unclear whether laparoscopy or robotic surgery confers lower ileus rates. Furthermore, the literature lacks consistency in defining ileus and does not adequately address the severity levels of this complication. This study aims to compare the incidence and severity of ileus after open, laparoscopic, and robotic oncologic rectal resections, using definitions established in the current literature. Methods: This is a retrospective cohort study including patients who underwent rectal resection in a single tertiary academic-affiliated hospital between the years 2014 and 2019. The study compared patients who underwent laparoscopic and robotic surgeries to those who underwent open surgery. Results: The study involved 337 patients who underwent oncologic rectal resection. Among them, 188 underwent laparoscopic, 59 robotic and 90 underwent open surgery. The overall incidence of postoperative paralytic ileus (POI) was 19.6%, with a significant difference observed between surgical approaches: 15.4% in the MIS group compared to 31.1% in the open surgery group (p < 0.001). Additionally, a lower ileus incidence was noted between the robotic (8.5%) and laparoscopic (17.6%) subgroups, but it did not reach statistical significance (p = 0.092). The severity of ileus did not differ significantly between laparoscopic, robotic and open surgery. Ileus risk factors that were found included advanced age, male gender, high ASA score, preoperative anemia, intraoperative bowel injury, and postoperative opioid use. Conclusions: MIS for rectal cancer is linked to a significantly lower rate of POI compared to open surgery. However, when ileus does occur, its severity is comparable across all techniques.

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.

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.