Rectal cancer surgery: is robotic surgery supported by solid evidence?

Robotic surgery for rectal cancer has gained increasing momentum over the last two decades. Minimally invasive surgery (MIS) has led to improved recovery time, shorter hospital length of stay (LOS), and decreased postoperative pain. Despite landmark studies comparing laparoscopic to open rectal cancer surgery failing to demonstrate noninferiority, several multicenter randomized clinical trials have shown similar oncological outcomes including local recurrence, disease-free survival (DFS), and overall survival (OS). Robotic-assisted laparoscopic surgery enhances elements to MIS including improved ergonomics causing less physical demand to the surgeon, better visualization with three-dimensional imaging, additional dexterity through flexible surgical instruments, and ability to navigate narrow spaces such as the pelvis. Robotic surgery has been shown to have similar oncological results when compared to open surgery. Although studies have not demonstrated superior oncologic outcomes with robotic surgery compared to laparoscopy, urogenital and sexual dysfunction may be improved with the robotic approach. Limitations to robotic surgery include increased cost, accessibility, and length of operation, although these factors may improve as surgeon experience grows. Recent trends have shown rapid expansion of the use of robotic surgery in the treatment of rectal cancer. The aim of this review article is to provide insight into the current evidence regarding robotic surgery for the treatment of rectal cancer.