Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision for rectal cancer: COLRAR randomized clinical trial
In brief
Robotic and laparoscopic rectal surgery yield similar five-year cancer outcomes
Among 295 patients with rectal cancer, five-year overall survival was about 92% and relapse-free survival about 82% with either robotic or laparoscopic surgery. A post-hoc analysis found better local recurrence-free survival with robotic surgery among patients who received preoperative chemoradiotherapy, but this subgroup signal needs confirmation in a prospective study.
- Journal
- The British journal of surgery (Q1)
- Published
- 5 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Seung Ho Song, Byung Soh Min, Jun Seok Park, Kang Young Lee, Nam Kyu Kim, Seon-Hahn Kim, et al.
- PMID
- 42929021
- DOI
- 10.1093/bjs/znag114
Why clinicians should know about it
- Picked for Surgical Oncology (top studies of the week, 8 November 2026): Randomized trial reports long-term oncologic outcomes after rectal resection
- Picked for Surgery (top studies of the week, 8 November 2026): Randomized robotic versus laparoscopic rectal cancer surgery outcomes
Abstract
BACKGROUND: Long-term oncological equivalence of robotic total mesorectal excision (R-TME) and laparoscopic total mesorectal excision (L-TME) remains unproven. The 5-year outcomes of the COLRAR RCT are reported. METHODS: Adults with cT1-4a Nx M0 rectal adenocarcinoma within 10 cm of the anal verge were randomized 1 : 1 to L-TME or R-TME at three Korean tertiary centres between July 2011 and February 2016. Pre-specified secondary endpoints were 5-year overall, relapse-free, local recurrence-free, and distant recurrence-free survival. Analyses were on a modified intention-to-treat basis. RESULTS: Of 295 analysed patients (144 L-TME patients and 151 R-TME patients; median follow-up of 72.6 months), 5-year overall survival (92.6% versus 92.4%; P = 0.838) and relapse-free survival (81.9% versus 83.0%; P = 0.801) were similar. Local recurrence occurred in 4.9% (L-TME) and 1.3% (R-TME); 5-year local recurrence-free and distant recurrence-free survival did not differ (P = 0.076 and P = 0.655). In a post-hoc analysis of 146 patients who received neoadjuvant chemoradiotherapy, 5-year local recurrence-free survival was 98.6% in R-TME patients versus 90.7% in L-TME patients (P = 0.039). CONCLUSION: R-TME and L-TME produced equivalent 5-year oncological outcomes. A post-hoc analysis suggested improved local control with robotic surgery after neoadjuvant chemoradiotherapy, requiring confirmation in prospectively designed studies. REGISTRATION NUMBER: NCT01423214 (http://www.clinicaltrials.gov).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.