Outcomes of Robot-Assisted Surgery in Rectal Cancer Compared with Open and Laparoscopic Surgery

Simple Summary Surgery is the mainstay treatment for patients with rectal cancer. Open and laparoscopic surgeries have been used for many years, but robot-assisted surgery has been recently developed and is expanding rapidly. We compared the results of robotic rectal surgery with open and laparoscopic methods. We found that robotic surgery has better outcomes than open surgery in bleeding, infection, hospital stay, and complete tumor resection. Similarly, robotic surgery did better than the laparoscopic approach in bleeding, need for reoperation, and complete tumor resection. Robotic surgery, however, incurred longer operation times and higher costs than open and laparoscopic surgery did. With increasing trends for the adoption of robotic surgery, many centers are considering changing their practices from open or laparoscopic to robot-assisted surgery for rectal cancer. We compared the outcomes of robot-assisted rectal resection with those of open and laparoscopic surgery. We searched Medline, Web of Science, and CENTRAL databases until October 2022. All randomized controlled trials (RCTs) and prospective studies comparing robotic surgery with open or laparoscopic rectal resection were included. Fifteen RCTs and 11 prospective studies involving 6922 patients were included. The meta-analysis revealed that robotic surgery has lower blood loss, less surgical site infection, shorter hospital stays, and higher negative resection margins than open resection. Robotic surgery also has lower conversion rates, lower blood loss, lower rates of reoperation, and higher negative circumferential margins than laparoscopic surgery. Robotic surgery had longer operation times and higher costs than open and laparoscopic surgery. There were no differences in other complications, mortality, and survival between robotic surgery and the open or laparoscopic approach. However, heterogeneity between studies was moderate to high in some analyses. The robotic approach can be the method of choice for centers planning to change from open to minimally invasive rectal surgery. The higher costs of robotic surgery should be considered as a substitute for laparoscopic surgery (PROSPERO: CRD42022381468).