Top Line: Laparoscopic approaches to total mesorectal excision (TME) for rectal cancers are commonly preferred over open approaches to ease patient recovery, but concerns remain over less complete resections.
The Study: Enter robotic TME, touted to improve completeness of resection via “3-dimensional vision, a stable camera platform, and flexible robotic arms.” The Chinese phase 3 REAL trial randomized 1171 patients with middle to low rectal cancers to robotic (n=586) versus in the laparoscopic (n=585) surgery. The ambitious primary endpoint of locoregional recurrence at 3 years was indeed significantly improved from 4% after laparoscopic to 1.6% with robotic surgery. In fact, even disease-free survival was significantly improved from 83 → 87%. There also appeared to be better sparing of urinary, rectal and sexual function per patient-reported outcomes.
TBL: The first randomized trial of its kind demonstrates superior oncologic outcomes with well-trained and experienced robotic versus laparoscopic total mesorectal excision for middle to low rectal cancer. | Feng, JAMA 2025
The Study: Enter robotic TME, touted to improve completeness of resection via “3-dimensional vision, a stable camera platform, and flexible robotic arms.” The Chinese phase 3 REAL trial randomized 1171 patients with middle to low rectal cancers to robotic (n=586) versus in the laparoscopic (n=585) surgery. The ambitious primary endpoint of locoregional recurrence at 3 years was indeed significantly improved from 4% after laparoscopic to 1.6% with robotic surgery. In fact, even disease-free survival was significantly improved from 83 → 87%. There also appeared to be better sparing of urinary, rectal and sexual function per patient-reported outcomes.
TBL: The first randomized trial of its kind demonstrates superior oncologic outcomes with well-trained and experienced robotic versus laparoscopic total mesorectal excision for middle to low rectal cancer. | Feng, JAMA 2025