Patients with rectal cancer requiring total mesorectal excision (TME) surgery often undergo laparoscopic procedures owing to the advantages of minimal tissue trauma and rapid recovery, although oncological outcomes remain controversial. Now, data from the randomized, prospective multicentre REAL trial provide high-quality evidence supporting the use of robot-assisted laparoscopic surgery.

A total of 1,240 patients with resectable stage I–III middle or lower rectal cancer (defined as the inferior edge of the tumour <10 cm from the anal verge on rigid proctoscopy) were randomly assigned (1:1) to undergo robot-assisted versus non-robot-assisted laparoscopic surgery. Three-year locoregional recurrence (LRR) was the primary end point.