Robotic versus laparoscopic approaches for rectal cancer: a systematic review and meta-analysis of postoperative complications, anastomotic leak, and mortality.

Abstract

Objective: Compare the efficacy and safety of robotic versus laparoscopic approach for rectal cancer treatment, addressing the ongoing debate within the medical community regarding the optimal surgical approach.

Background: Traditionally, surgery has been the cornerstone of rectal cancer treatment, aimed at tumor removal and intestinal function preservation. Recent advancements have introduced laparoscopic and robotic surgeries as minimally invasive alternatives to conventional methods. However, it faces limitations in instrument mobility and dexterity. Robotic approach, on the other hand, enhances these aspects by providing surgeons with advanced precision, a three-dimensional high-definition view, and superior tissue manipulation capabilities, making it an increasingly preferred option for rectal cancer treatment.

Methods: This systematic review and meta-analysis following PRISMA-2020 guidelines was carried out. This study analyzed phase 2 and 3 randomized controlled trials assessing the efficacy and safety of robotic versus laparoscopic approach in treating rectal cancer. Only studies meeting specific criteria were included, with congress abstracts, narrative reviews, case reports, and letters to the editor excluded.

Results: We identified 350 studies, 8 met the inclusion criteria, encompassing 2525 patients from diverse geographical locations. The main outcomes analyzed were regional recurrence, anastomotic leak, postoperative complications, and mortality. The findings indicated no significant differences between robotic and laparoscopic surgeries in terms of Grade III Clavien-Dindo complications, mortality, and anastomotic leakage. The diverse geographical origin of the studies suggests the applicability of the results across different health care settings, although system-specific considerations are essential.

Conclusion: Robotic approach does not show significant advantages over laparoscopic approach in terms of major complications and mortality rates in rectal cancer treatment, indicating that both surgical approaches are viable options with their specific benefits and limitations.