Robotic vs Laparoscopic Surgery for Middle and Low Rectal Cancer

作者：Qingyang Feng, Weitang Yuan, Taiyuan Li, Bo Tang, Baoqing Jia, Yanbing Zhou, Wei Zhang, Ren Zhao, Cheng Zhang, Longwei Cheng, Xiaoqiao Zhang, Ye Wei, Fei Liang, Guodong He, Jianmin Xu, REAL Study Group, Zhenqiang Sun, Bo Tang, Linfeng Gao, Peng Li, Xiaodong Liu, Zheng Lou, Tao Zhang, Da Li, Zhaocheng Chi, Guang Yang · 发表于：JAMA · 年份：2025 · DOI：10.1001/jama.2025.8123 · 被引用次数：110 · 研究领域：Colorectal Cancer Surgical Treatments、Stoma care and complications、Colorectal and Anal Carcinomas

Importance: Robotic surgery for rectal cancer is widely used, but data on long-term oncological outcomes are still lacking. Objective: 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. Results: Of the 1240 patients enrolled, 1171 were included in the primary analysis (586 in the robotic surgery group; mean age, 59.1 [SD, 11.0] years; and 356 were men [60.8%] vs 585 in the laparoscopic surgery group; mean age, 60.7 [SD, 9.8] years; and 354 were men [60.5%]). The median follow-up time was 43.0 months (IQR, 36...