Robotic surgery boosts 3-year relapse-free survival in rectal cancer

Editor's Note

Robotic surgery improves 3-year relapse-free survival compared with laparoscopic surgery for rectal cancer, according to findings presented at the 2025 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, published by Gastroenterology & Endoscopy News on August 18.

As detailed in the article, researchers conducted a multicenter cohort study of 1,053 patients with stage I to III middle or low rectal adenocarcinoma who underwent either robotic (n=536) or laparoscopic (n=517) elective surgery. The primary endpoint was 3-year relapse-free survival, with secondary measures including postoperative complications, overall survival, complete resection, and anastomotic leakage rates.

Relapse-free survival was higher among robotic surgery patients (83.6% vs 78.2%), with a hazard ratio of 0.72. Pathologic complete resection was also more likely in the robotic group (98.2% vs 95.4%). While blood loss was comparable between groups, anastomotic leakage occurred in 5.6% of robotic cases and 4.0% of laparoscopic cases, a difference that did not reach statistical significance. The overall complication rate was slightly lower in the robotic group (28.4% vs 32%).

The outlet reports that robotic surgery also trended toward higher 3-year overall survival (94.4% vs 90.6%) and lower local recurrence (4.6% vs 6.4%). Rates of liver, lung, and peritoneal recurrence were also reduced in robotic cases. Subgroup analysis showed the strongest benefit in men and in patients with cT4 tumors, while patients older than 80 saw no advantage from robotic procedures.

The researchers noted longer operative times were observed in the robotic group (435 vs 366 minutes), which they attributed to limited early experience with robotic systems. They speculated that prolonged anesthesia could help explain the lack of benefit in older patients. The article concludes that robotic surgery offers real-world long-term survival advantages over laparoscopic surgery for rectal cancer, though its benefit appears limited in older adults.