A multicentre, randomized, controlled superiority trial (REAL) assessed patients (n = 1,171) with middle and low rectal cancer for surgical quality and clinical outcomes after robotic (n = 586) and laparoscopic (n = 585) surgery. Of the patients in the robotic group, 95.4% reached a macroscopic complete resection versus 91.8% of the patients in the laparoscopic group. In addition, patients in the robotic group had less surgical trauma and better postoperative gastrointestinal recovery than those in the laparoscopic group.