Robotic surgery improves outcomes, compared with conventional laparoscopic surgery, for patients with middle and low rectal cancer, according to study findings published in The Lancet Gastroenterology and Hepatology.

Robotic surgery resulted in improved quality of resection, faster postoperative recovery, fewer postoperative and intraoperative complications, shorter hospital stays, and decreased surgical trauma, researchers found.

Researchers conducted a multicenter, randomized, controlled superiority trial to compare the outcomes of robotic vs laparoscopic surgical procedures in 1240 patients with middle or low rectal cancer.

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The researchers randomly assigned 620 patients to robotic surgery and 620 to conventional laparoscopic surgery, ultimately excluding 34 and 35 patients from each group, respectively. Interventional cross-over occurred with 6 patients in the robotic surgical group receiving laparoscopic surgery, while 7 patients in the laparoscopic group received robotic surgery.

In the robotic surgical group, 4% of patients (22/547) demonstrated positive circumferential resection margins compared with 7.2% of patients (39/543) in the laparoscopic surgical group (difference, -3.2%; 95% CI, -6.0 to -0.4; P =.023).

Fewer patients in the robotic surgical group experienced 1 or more postoperative complications within 30 days of operation compared with those in the laparoscopic surgical group (16.2% vs 23.1%, respectively; difference, -6.9%; 95% CI, -11.4 to -2.3; P =.003).

Additionally, patients who underwent robotic surgery had shorter hospital stays (median 7 days vs 8 days, P =.0001), fewer abdominoperineal resections (16.9% vs 22.7%), fewer conversions to open surgery (1.7% vs 3.9%; P =.021), fewer intraoperative complications (5.5% vs 8.7%, P =.030), and less estimated blood loss (median, 40 mL vs 50 mL, P <.0001) than patients in the laparoscopic group.

“Robotic surgery for middle and low rectal cancer by experienced surgeons could improve surgical quality compared with conventional laparoscopic surgery,” the study authors noted. “Whether robotic surgery results in fewer locoregional recurrences and better long-term outcomes compared with laparoscopic surgery will be addressed upon completion of this trial.”


Feng Q, Yuan W, Li T, et al. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. Published online September 7, 2022:S2468-1253(22)00248-5. doi:10.1016/S2468-1253(22)00248-5

This article originally appeared on Gastroenterology Advisor