The perioperative results of robotic and laparoscopic surgery for rectal cancer in obese patients: a systematic review and meta-analysis

Background: The incidence of rectal cancer (RC) among obese patients is gradually increasing. Obesity can elevate the risk of RC surgery in numerous aspects. This paper aims to compare the perioperative results of robotic and laparoscopic surgery for RC in obese patients Methods: We conducted a standardized search of relevant articles using PubMed, Cochrane Library and Web of Science Core Collection in December 2024. All original research articles relevant to our topic were incorporated into the literature screening process, including randomized controlled trials, prospective cohort studies, and retrospective cohort studies. Study selection was subsequently performed according to predefined inclusion and exclusion criteria. Results: This study selected five studies, involving 499 patients. Among these patients, 191 underwent robotic surgery, while the remaining 308 underwent laparoscopic surgery. The results showed that for obese patients with RC, robotic rectal cancer surgery (RRCS) is more effective in reducing hospital stay (WMD, -1.67; p = 0.00001), the rate of overall postoperative complications (OR, 0.41, p = 0.02), and the readmission rate (OR, 0.37; p = 0.03) compared to laparoscopic rectal cancer surgery (LRCS), albeit with longer operative times (WMD, 41.38; p = 0.006). No statistically significant differences were observed between the two surgical methods in terms of estimated blood loss, conversion rates, lymph node yield, positive CRM rates, diverting stoma rates, anastomotic leakage rates, urinary retention rates, and reoperation rates. Conclusions: For obese patients, RRCS may offer certain potential advantages over LRCS, including a shorter hospital stay, lower overall postoperative complication rates, and lower readmission rates. However, it also involves a longer operative time. These findings suggest that RRCS has the potential to be a safer and more beneficial alternative for obese patients with RC. © The Author(s) 2025.