Perioperative outcomes of robotic-assisted vs. conventional laparoscopy for colorectal cancer resection: a systematic review and meta-analysis

TL;DR

This study compares robotic-assisted and conventional laparoscopic surgery for colorectal cancer, finding robotic surgery reduces conversion and re-operation rates but takes longer.

Contribution

A systematic review and meta-analysis comparing perioperative outcomes of robotic-assisted and conventional laparoscopic colorectal cancer surgery.

Findings

Robotic-assisted surgery (RAS) had longer operative times but lower conversion and re-operation rates.

RAS reduced complications in colorectal cases but not in rectal cases.

Hospital stays were shorter with RAS compared to conventional laparoscopic surgery.

Abstract

Colorectal cancer is a major global health concern that requires successful surgical treatments. While robotic-assisted surgery (RAS) provides prospective improvements, laparoscopic surgery has proven to yield better results than open surgeries.

From 2018 to December 2024, PubMed, Scopus, and Web of Science were used to perform a systematic review and meta-analysis of cohort studies and randomized controlled trials (RCTs). Studies comparing RAS and conventional laparoscopic surgery were included. The primary outcomes assessed were length of hospital stay, conversion to open surgery, postoperative complications, and operating time. Using Comprehensive Meta-Analysis software, statistical analysis was performed, including subgroup analyses by anatomical site (colon, rectum, colorectal). Sensitivity analyses and heterogeneity were conducted.

21 studies involving over 70,000 patients were included. The meta-analysis demonstrated significantly longer operative times with RAS (MD = 0.161–1.049, p < 0.001). RAS was linked to a significantly lower chance of re-operative rates (RR = 0.549, p = 0.023) and a significantly lower risk of conversion to open surgery (RR = 0.412–0.592, p < 0.001). RAS decreased problems in the colorectal group (RR = 0.867, p = 0.023), but overall rectum group complication rates were comparable. Hospital stays were shorter after robotic-assisted surgery (MD = −0.284 to −0.755, p = 0.001).

When compared to CLS, RAS has the advantage of lowering conversion and re-operation rates, albeit at the expense of higher operating time. CLS led to shorter hospital stays, but in some circumstances, the complication rates were on level with or lower than those of RAS. According to these results, RAS might be useful in some surgical situations and patient demographics.

https://www.crd.york.ac.uk/PROSPERO/view/614084, PROSPERO CRD42024614084.

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