Background: Robotic surgery for rectal cancer is popular, but persuasive evidence of long-term oncological outcomes in real-world populations is still lacking. Materials and Methods: This retrospective cohort study emulated the target trial to compare surgical quality and long-term oncological outcomes between robotic and conventional laparoscopic surgery for middle and low rectal cancer in real-world populations. Patients were consecutively enrolled from a multicenter cohort database in Shanghai, China, with middle or low rectal adenocarcinoma, cT1–T3 N0–N1 or ycT1–T3 Nx, no distant metastasis. Eligible patients were classified into robotic or laparoscopic groups and propensity score matched at a 1:1 ratio. The primary endpoint was 3-year disease-free survival rate. Results: From 3742 eligible patients, 2702 were included in primary analyses after matching: 1351 in robotic group and 1351 in laparoscopic group. The median follow-up time was 42.4 months (interquartile range = 39.5–45.3). The robotic group had higher 3-year disease-free survival rate (86.7% vs. 83.3%, p = 0.017, unadjusted hazard ratio HR = 0.800, 95% confidence interval CI = 0.666–0.961, adjusted HR = 0.786, 95% CI = 0.654–0.945). The robotic group also had lower 3-year locoregional recurrence rate (2.2% vs. 4.7%, p = 0.001), lower 30-day postoperative complication rate (14.3% vs. 19.5%, p < 0.001), lower abdominoperineal resection rate (7.5% vs. 12.4%, p < 0.001), and lower circumferential resection margin positivity rate (2.2% vs. 4.2%, p = 0.005). No significant difference in 3-year overall survival rate was observed (96.4% vs. 95.5%, p = 0.063). Conclusions: Compared with conventional laparoscopic surgery, robotic surgery significantly improved long-term oncological outcomes and short-term recovery of middle and low rectal cancer in real-world populations.
Wang et al. (Mon,) studied this question.