Comparison of Functional Outcomes Between Robotic and Laparoscopic Surgery in Rectal Cancer Patients: Systematic Review and Meta-Analysis

Clinical Snapshot

Key Findings

• P Value: Not significant for most outcomes

• Effect Size: Lower urinary retention with robotic surgery, no significant differences in other functional outcomes

• Primary Outcome: Functional outcomes (urinary retention, urinary function, sexual function)

• Nnt Or Sensitivity: Not reported - effect sizes described as clinically modest

• Confidence Interval: Not reported in abstract

Clinical Application

Limited by availability of robotic systems and trained surgeons, higher costs compared to laparoscopy Relevant to Australian colorectal surgery practice; robotic systems available in major centres but cost-effectiveness considerations important for PBS and hospital budgets Adult patients with rectal cancer suitable for minimally invasive surgery

Abstract

BACKGROUND: Robotic and laparoscopic approaches are widely used for rectal cancer surgery. Although robotic systems provide enhanced visualization and dexterity, it remains unclear whether these advantages improve postoperative urinary and sexual function. METHODS: MEDLINE, Embase, Web of Science, and CENTRAL (2000-2025) were searched for studies comparing robotic and laparoscopic rectal cancer surgery. Outcomes included postoperative ileus, urinary retention, and urinary and sexual function. Random-effects meta-analysis was performed using RevMan. Study quality was assessed with MINORS, and certainty of evidence with GRADE. Publication bias was evaluated using funnel plots and Egger's test. RESULTS: Forty-four observational studies (6,121 patients) were included. Robotic surgery was associated with lower urinary retention, though this may reflect publication bias. No significant difference was found in postoperative ileus. Subgroup analyses at 3, 6, and 12 months showed no significant differences in urinary or sexual function. Although pooled results slightly favored robotic surgery, these effects were inconsistent, not sustained, and clinically modest. CONCLUSION: Robotic surgery may reduce urinary retention but shows no consistent functional superiority over laparoscopy. Outcomes at key follow-up points are comparable. As all studies were observational, evidence certainty is low, and findings should be interpreted cautiously. This study provides an updated and comprehensive synthesis of functional outcomes following robotic versus laparoscopic rectal cancer surgery, with a specific focus on clinically relevant time-point analyses (3, 6, and 12 months). Unlike prior meta-analyses, which often emphasize pooled outcomes across heterogeneous follow-up periods, this study demonstrates that no consistent or durable improvements in urinary or sexual function are observed at predefined postoperative intervals. Furthermore, by integrating GRADE-based certainty assessment, this work highlights that the current evidence is predominantly observational and of low to very low certainty. Importantly, the study incorporates contemporary evidence up to 2025, including recent systematic reviews and randomized data, and provides a clinically grounded interpretation by contextualizing effect sizes against minimal clinically important difference (MCID) thresholds. Collectively, this analysis offers a more cautious and clinically meaningful appraisal of functional outcomes, challenging assumptions of functional superiority associated with robotic rectal surgery.

References

1. 1.Wang, Y., Wang, W., Du, Y., & Li, H. (2026). Comparison of functional outcomes between robotic and laparoscopic surgery in rectal cancer patients: Systematic review and meta-analysis. Journal of Investigative Surgery, 1-15. https://doi.org/10.1080/08941939.2026.2652787