Robotic-Assisted vs Conventional Laparoscopic Surgery for Rectal Cancer.

As it is well known, minimally invasive surgery has gradually gained field in the treatment of malignant colorectal diseases. However, controversy is still present regarding the feasibility of the laparoscopic approach for the treatment of rectal cancer. This is probably due to the difficulty of performing surgery in deep pelvises with rigid instruments. The more recent introduction of the robotic platform was supposed to well overcome these limits. However, the recent publication of the ROLARR Clinical Trial did not report any significant difference in terms of peri-operative and functional (sexual and urinary) outcomes as compared to the laparoscopic approach. At this regard, we would like to address you our Letter to the Editor Robot-assisted vs conventional laparoscopic surgery for rectal cancer. In our opinion, significant biases affected the study, leading to not reliable results. The three main criticisms we pointed out are: - The evident insufficient surgeons’ experience - The high (and poorly defined) intra-operative complication rate - The inaccuracy in the definition of the short-term outcomes (fundamental for defining the feasibility of a new surgical approach). We believe that surgeons’ experience and standardization of the surgical technique are essential when designing such important trials, especially for the need to obtain conclusive data on the effectiveness of the robotic platform in the treatment of rectal cancer.