Robotic vs Laparoscopic Surgery for Middle and Low Rectal Cancer

Robotic surgery for rectal cancer is widely used, but data on long-term oncological outcomes are still lacking.

To compare the 3-year locoregional recurrence rates of middle and low rectal cancer in patients who underwent robotic surgery vs conventional laparoscopic surgery. Design, Setting, and Participants: In this multicenter, superiority, randomized clinical trial, patients with middle or low rectal adenocarcinoma (cT1-T3, N0-N1, or ycT1-T3 Nx) and no distant metastasis were enrolled at 11 centers across 8 provinces in China from July 2016 to December 2020. Among the 1742 consecutive patients assessed for eligibility, 1240 were eligible and randomized. Follow-up continued until December 31, 2023. Interventions: Patients were randomized 1:1 to undergo robotic or conventional laparoscopic rectal cancer resection. Main Outcomes and Measures: The primary outcome was the 3-year locoregional recurrence rate. The primary analysis was performed as randomized, but excluded patients deemed ineligible after randomization. The secondary outcomes included disease-free survival; overall survival; and urinary, sexual, and defecation function.