Short-term outcomes of single-port versus multi-port robotic surgery for colorectal cancer: a propensity score-matched analysis.

BACKGROUND: Single-port robotic surgery may reduce incision burden compared with multi-port robotic surgery. However, its feasibility for colorectal cancer surgery remains unclear, particularly with respect to short-term surgical outcomes and pathological findings. METHODS: In this retrospective cohort study, we compared patients with clinical stage I-III colorectal adenocarcinoma who underwent single-port or multi-port robotic colorectal cancer surgery between January 2024 and December 2025. One-to-one propensity score matching was applied to balance baseline confounders. A sensitivity analysis using inverse probability of treatment weighting was also performed to assess robustness. RESULTS: After matching, 104 patients per group were analyzed. Unadjusted operative time was shorter in the single-port group (median [interquartile range], 203 [165-277] vs. 223 [174-308] minutes; p = 0.042), although multivariable analysis showed no independent association between the platform and operative time. Estimated blood loss did not differ significantly (12 [6-18] vs. 10 [5-24] mL; p = 0.582). C-reactive protein levels on postoperative day (POD) 1 (2.50 [1.78-3.74] vs. 3.17 [1.68-4.95] mg/dL; p = 0.048) and visual analog scale pain scores at 24 h after surgery (8 [0-20] vs. 11 [3-20]; p = 0.038) were lower in the single-port group; however, CRP levels were comparable on POD3 (4.80 [2.64-6.97] vs. 4.97 [2.17-7.03] mg/dL; p = 0.887). The single-port group had fewer incisions and a shorter total incision length (4.7 [4.2-5.2] vs. 7.3 [7.3-8.3] cm; p < 0.001). Pathological findings were comparable, including lymph node yield (18 [11-27] vs. 17 [10-25]; p = 0.560) and radial margin positivity (1.0% vs. 3.8%; p = 0.369). Severe complications and length of stay were similar. CONCLUSION: Single-port robotic surgery was feasible and achieved perioperative safety comparable to multi-port robotic surgery. It was associated with reduced incision burden and favorable results in selected early postoperative recovery metrics, while showing comparable short-term pathological findings.