A systematic review and meta-analysis of laparoscopic versus robotic rectal surgery with primary anastomosis

Purpose: Rectal cancer is one of the most common malignancies of the gastrointestinal tract. The gold standard method is surgical resection. The approach to rectal cancer is still controversial. Nowadays, robotic approach gains popularity in comparison to traditional laparoscopy. However,there is a lack of studies assessing rectal resections with primary anastomosis. Methods: We performed a systematic review and meta-analysis according to the PRISMA guidelines. The primary outcomes of interest were morbidity and short-term complications. Results: An initial reference search yielded 1250 articles. Finally, we chose six studies covering 1580 patients that we included in the quantitative analysis. In our study, we demonstrated that laparoscopic and robotic surgery are non-inferior to one another in terms of morbidity (RR = 1.1 95% CI: 0.89-1.39), major complication rate (RR = 1.01, 95% CI: 0.60-1.69) or length of hospitalization (MD = 0.15 95% CI: -0.60-0.90). The latter has a slight advantage in the quality of mesorectal excision (RD -0.19, 95% CI: -0.35 --0.03. l2 = 69%) and anastomotic leakage rate (OR = 2.25, 95% CI: 1.23 4.09, l2 = 0%). Conclusion: In certain cases, RoboticSurgery provides better quality of resected specimen and lower leakage ratio; nevertheless due to heterogeneity the results are uncertain. There is a substantial need for large randomized controlled studies.