6/29/23, 12:44 AM REAL Pathway Feedback Search Clinical Topics Home Studies REAL REAL Disease Rectal cancer Trial question Is robotic surgery superior to laparoscopic surgery in patients with middle and low rectal cancer? Study design Multi-center Open label RCT Population 1171 patients Inclusion criteria: patients with middle or low rectal adenocarcinoma with no evidence of distant metastasis Key exclusion criteria: tumor assessed as clinical complete response after preoperative radio- or chemoradiotherapy or suitable for local excision; signs of acute intestinal obstruction, bleeding or perforation needing emergency surgery Interventions N=586 robotic surgery (robot-assisted resection using da Vinci system) N=585 laparoscopic surgery (traditional laparoscopic resection) Primary outcome Circumferential resection margin positivity 7.2 % 7.2 5.4 % 4 3.6 % Significant decrease 1.8 % https://web.pathway.md/studies/recY9xlnFTw3X5xHK 1/2 6/29/23, 12:44 AM REAL Pathway NNT = 31 0.0 % Robotic surgery Laparoscopic surgery Significant decrease in circumferential resection margin positivity (4% vs. 7.2%; ARD -3.2, 95% CI -6 to -0.4) Secondary outcomes Significant decrease in postoperative complication grade II at day 30 (16.2% vs. 23.1%; ARD -6.9, 95% CI -11.4 to -2.3) Significant increase in macroscopic complete resection (95.4% vs. 91.8%; AD 3.6%, 95% CI 0.8 to 6.5) Significant decrease in postoperative hospital stay (7 days vs. 8 days; AD -1 days, 95% CI -1 to 0) Conclusion In patients with middle or low rectal adenocarcinoma with no evidence of distant metastasis, robotic surgery was superior to laparoscopic surgery with respect to circumferential resection margin positivity. Reference Qingyang Feng, Weitang Yuan, Taiyuan Li et al. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. 2022 Sep 7;S2468-1253(22)00248-5. Open reference URL https://web.pathway.md/studies/recY9xlnFTw3X5xHK 2/2