Robotic versus laparoscopic low anterior resection for rectal cancer: A systematic review and meta-analysis

The purpose of the review is to establish the safety and efficacy of robotic-assisted colorectal surgery (RAS) and laparoscopic colorectal surgery (LAS) for colorectal disease based on randomized controlled trial studies. The objective of this study is to evaluate two different operative interventions for short-term outcomes. The short-term outcomes include the conversion rate to open operation, intraoperative bleeding, operation time, length of hospital stay, number of lymph nodes harvested, peri-operative complications, and clear pathological resection margins. A search of MEDLINE at EBSCOhost, EMBASE, and Cochrane Library for articles from 1991 to 2020 was performed to identify randomized controlled trial studies that compared the clinical or oncologic outcomes of RAS and LAS. A meta-analysis was performed using the Review Manager (RevMan5.3) software. The data used were mean differences and odds ratios for continuous and dichotomous variables, respectively. Fixed-effects or random-effects models were adopted according to heterogeneity. Ten randomized controlled trial studies were included in the meta-analysis; 687 patients underwent RAS and 794 patients underwent LAS. The results revealed that conversion rates [relative risk (RR) =0.36, 95% confidence index (CI) =0.23–0.55, P < 0.00001], estimated blood losses [mean deviation (MD) = -15.01, 95% CI = -23.93–6.08, P = 0.0010], length of hospital stay (MD = -0.78, 95% CI = -1.11–0.46, P < 0.00001), and complications [odds ratio (OR) =1.04, 95% CI = 0.73–1.48, P = 0.97] were significantly reduced following RAS compared to that with LAS. There were no significant differences in operation time (MD = 0.61, 95% CI = -3.48–4.71, P = 0.77), number of lymph nodes harvested (MD = -0.08, 95% CI = -1.03–0.88, P = 0.87), and circumferential resection margin non-involvement (OR = 1.40, 95% CI = 0.88–2.25, P = 0.16) between the two techniques. The meta-analysis favored the robot-assisted technique. RAS is a promising technique and is a safe and effective alternative to LAS for colorectal surgery. The advantages of RAS include lower conversion rates, shorter hospital stay, and less intraoperative bleeding and complications. Further studies are required to define the effects of RAS on quality of life and long-term oncologic outcomes.