Robotic and laparoscopic TME gave the same five-year survival in COLRAR

Design

Randomised trial, five-year secondary endpoints, modified intention to treat

Population

295 adults with rectal adenocarcinoma within 10 cm of anal verge, Korea

Primary outcome

Five-year overall and relapse-free survival (pre-specified secondary)

Effect

OS 92.4% vs 92.6% (P = 0.838); RFS 83.0% vs 81.9% (P = 0.801)

COLRAR randomised adults with rectal adenocarcinoma within 10 cm of the anal verge to robotic or laparoscopic total mesorectal excision at three Korean tertiary centres between 2011 and 2016. These are the five-year secondary oncological endpoints for 295 analysed patients, median follow-up 72.6 months.

Five-year overall survival (92.4% robotic vs 92.6% laparoscopic) and relapse-free survival (83.0% vs 81.9%) were similar. Local recurrence was 1.3% after robotic and 4.9% after laparoscopic surgery, but local recurrence-free survival did not differ significantly (P = 0.076). In a post-hoc look at the 146 patients who had neoadjuvant chemoradiotherapy, local recurrence-free survival was 98.6% robotic versus 90.7% laparoscopic.

For units choosing between platforms, oncological outcome is not the deciding factor: both approaches performed well in experienced hands. The chemoradiotherapy signal is interesting but post hoc and should not drive case selection.

• Choose robotic or laparoscopic TME on surgeon expertise, access and cost; five-year oncology was equivalent
• Audit local recurrence in your own unit whichever platform you use
• Do not select robotic surgery for irradiated patients on the basis of this post-hoc finding
• Results come from high-volume Korean centres; outcomes may differ on a learning curve

Why it matters

Removes oncological outcome as an argument for or against the robot in rectal cancer.

Don't overread it

The local-control advantage after chemoradiotherapy comes from a post-hoc subgroup and is hypothesis-generating only.

The statistics, in plain English

A P value of 0.076 for local recurrence means the difference could plausibly be chance. The post-hoc subgroup result (P = 0.039) was not planned in advance, and testing many subgroups makes a chance 'significant' finding likely.

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