Robotic operation resulted in improved quality of resection, faster postoperative recovery, fewer postoperative and intraoperative complications, shorter hospital stays, and decreased surgical trauma compared with conventional laparoscopic procedures for patients with middle and low rectal cancer, according to study findings published in the Lancet Gastroenterology and Hepatology.
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.
The researchers randomly assigned 620 patients to receive robotic operation and 620 to receive the conventional laparoscopic operation, ultimately excluding 34 and 35 patients from the 2 groups, respectively. Interventional cross-over occurred with 6 patients in the robotic surgical group receiving laparoscopic operation, while 7 patients in the laparoscopic group received robotic operation.
In the robotic surgical group, 22 (4%) of 547 patients demonstrated positive circumferential resection margins compared with 39 (7.2%) of 543 patients 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 operation demonstrated shorter hospital stays (median 7 days vs 8 days, P =.0001), improved gastrointestinal recovery, less 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 of 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.”
Study limitations include lack of standardized perioperative protocols due to the multicentric scope of the trial, the lack of generalizability to patients outside of the Chinese population, particularly regarding body mass index and visceral fat impacting minimally invasive surgical performance, and the use of experienced surgeons in this trial whereas widespread implementation of robotic surgical procedures may not be feasible due to lack of expertise or training.
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