2022 ASCO GI ｜ Voice of China: REAL study results show that robotic surgery can improve surgical injury in patients with low and middle rectal cancer

The 2022 American Society of Clinical Oncology Symposium on Gastrointestinal Oncology (ASCO-GI) will be held from January 20 to 22 local time
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Minimally invasive surgery is the mainstream of contemporary surgery, and robotic technology is a new trend in minimally invasive surgery
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At this ASCO GI meeting, Professor Xu Jianmin's team from Zhongshan Hospital Affiliated to Fudan University presented the research results of robotic surgery for rectal cancer compared with traditional laparoscopic surgery
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Background Robotic surgery for rectal cancer is gaining popularity, but long-term robust oncological evidence is lacking
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This study was a multicenter randomized controlled clinical trial comparing the effects of robotic surgery and traditional laparoscopic surgery on surgical quality and long-term oncological outcomes in patients with low- and mid-range rectal cancer
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Methods This superiority trial was conducted in 11 hospitals in 8 provinces in China
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Median (>7-12 cm from the anal verge) or low (0-7 cm from the anal verge) rectal glands with no evidence of distant metastasis in cT1-T3 N0-1 or ycT1-T3 Nx after preoperative RT/RT included Cancer patients were randomly assigned (1:1) to undergo robotic surgery or conventional laparoscopic surgery
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Secondary (short-term) study endpoints (surgical quality, pathological curativeness, and postoperative recovery) were compared using a modified intent-to-treat (mITT) analysis
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The primary endpoint is the three-year local recurrence rate, expected by the end of 2023
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This trial is registered with ClinicalTrials.
gov (NCT02817126)
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Results From July 2016 to December 2020, a total of 1240 patients were included, of which 1180 were included in the mITT analysis (591 in the robotic group and 589 in the laparoscopy group)
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There were significantly more sphincter-sparing procedures (low anterior resection) in the robotic group (83.
1% vs 76.
9%, p=0.
008)
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With more macroscopic complete resections (95.
4% vs 91.
9%, p=0.
012), robotic surgery had better mesorectal fascia integrity and lower positive circumcision margins (4.
0% vs 7.
1%, difference = -3.
1 %, 95% CI=-6.
0% vs -0.
5%, p=0.
023), and more lymph nodes were dissected (median 15.
0 vs 14.
0, p=0.
004)
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Robotic surgery also reduced conversion to laparotomy (1.
7% vs 3.
9%, p=0.
021), estimated blood loss (median 40.
0 ml vs 50.
0 ml, p<0.
001), and intraoperative complication rate (5.
4% vs 5.
4%) 8.
7%, p=0.
029) and 30-day postoperative complication rate (Clavien-Dindo ≥ grade II, 16.
1% vs 22.
9%, p=0.
003), resulting in improved postoperative recovery and reduced postoperative hospital stay ( Median days were 7.
0 days vs 8.
0 days, p<0.
001)
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The 30-day postoperative mortality was similar between the two groups (0.
2% vs 0.
2%, p>0.
999)
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Conclusion Compared with traditional laparoscopic surgery, robotic surgery for the treatment of middle and low rectal cancer significantly reduces the surgical injury, promotes the radical cure of the tumor, and improves the postoperative recovery of patients
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Reference: Rapid Abstract Session and Poster Session 14.
Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): Short- term outcomes of a multicenter randomized controlled trial.