Clinical Study Robotic-Assisted versus Conventional Laparoscopic Approach for Rectal Cancer Surgery, First Egyptian Academic Center Experience, RCT Yasser Debakey , 1 Ashraf Zaghloul, 2 Ahmed Farag, 3 Ahmed Mahmoud, 4 and Inas Elattar 5 1 Assistant Teacher of Surgical Oncology, National Cancer Institute, Cairo University, Egypt 2 Head of Robotic Surgery Unit, National Cancer Institute, Cairo University, Egypt 3 Head of Colorectal Surgery Unit, Faculty of Medicine, Cairo University, Egypt 4 Associated Professor of Surgical Oncology, National Cancer Institute, Cairo University, Egypt 5 Professor of Biostatistics and Cancer Epidemiology, National Cancer Institute, Cairo University, Egypt Correspondence should be addressed to Yasser Debakey; y.eldebakey@cu.edu.eg Received 28 August 2017; Revised 5 January 2018; Accepted 20 June 2018; Published 2 September 2018 Academic Editor: Diego Cuccurullo Copyright © 2018 Yasser Debakey et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Undoubtedly, robotic systems have largely penetrated the surgical feld. For any new operative approach to become an accepted alternative to conventional methods, it must be proved safe and result in comparable outcomes. Te purpose of this study is to compare the short-term operative as well as oncologic outcomes of robotic-assisted and laparoscopic rectal cancer resections. Methods. Tis is a prospective randomized clinical trial conducted on patients with rectal cancer undergoing either robotic-assisted or laparoscopic surgery from April 2015 till February 2017. Patients’ demographics, operative parameters, and short-term clinical and oncological outcomes were analyzed. Results. Fify-seven patients underwent permuted block randomization. Of these patients, 28 were assigned to undergo robotic-assisted rectal surgery and 29 to laparoscopic rectal surgery. Afer exclusion of 12 patients following randomization, 45 patients were included in the analysis. No signifcant diferences exist between both groups in terms of age, gender, BMI, ASA score, clinical stage, and rate of receiving upfront chemoradiation. Estimated blood loss was evidently lower in the robotic than in the laparoscopic group (median: 200 versus 325 ml, p= 0.050). A signifcantly more distal margin is achieved in the robotic than in the laparoscopic group (median: 2.8 versus 1.8, p< 0.001). Although the circumferential radial margin (CRM) was complete in 18 patients (85.7%) in the robotic group in contrast to 15 patients (62.5%) in the laparoscopic group, it did not difer statistically (p=0.079). Te overall postoperative complication rates were similar between the two groups. Conclusion. To our knowledge, this is the frst prospective randomized trial of robotic rectal surgery in the Middle East and Northern Africa region. Our early experience indicates that robotic rectal surgery is a feasible and safe procedure. It is not inferior to standard laparoscopy in terms of oncologic radicality and surgical complications. Organization number is IORG0003381. IRB number is IRB00004025. 1. Background Over the past two decades, rectal cancer management under- went an immense wave of change from various perspectives. Tere was a smart shif from open to minimally invasive and robotic techniques, a worldwide application of neoadjuvant multimodal chemoradiation therapy for locally advanced stage disease, as well as optimization of surgical technique with nerve preservation together with the introduction of total mesorectal excision (TME) which were all largely happening in the preceding 10–15 years. Te frst colorectal laparoscopic procedure was operated upon by Jacobs in 1991 [1]. A decade later, in 2001, the robotic system was introduced to colorectal surgery [2]. To date, laparoscopic surgery has been acknowledged as a safe and efective modality of rectal cancer surgery. However, a randomized controlled multicenter trial has recently suggested that the use of laparoscopic surgery in T3/T4 tumors may result in incomplete resection, afecting the oncological outcome in this group of patients [3]. Te Hindawi Minimally Invasive Surgery Volume 2018, Article ID 5836562, 11 pages https://doi.org/10.1155/2018/5836562