Perioperative and oncological outcomes of robotic versus laparoscopic low anterior resection in younger rectal cancer cohorts: a systematic review and meta-analysis with narrative functional assessment

Clinical Snapshot

Key Findings

• P Value: Conversion p<0.0001; Complications p=0.02; TME p=0.003

• Effect Size: R-LAR showed lower conversion rates (OR 0.38), lower overall complications (OR 0.84), higher complete TME rates (OR 3.30)

• Primary Outcome: Multiple perioperative outcomes assessed

• Nnt Or Sensitivity: For every 100 younger patients, robotic approach may prevent 16 conversions to open surgery and 16 overall complications

• Confidence Interval: Conversion: 95% CI 0.27-0.53; Complications: 95% CI 0.73-0.97; TME: 95% CI 2.14-5.10

Clinical Application

Requires significant infrastructure investment, surgeon training, and institutional commitment to robotic surgery programs Relevant to major Australian centres with da Vinci systems. Consider MBS item numbers for robotic procedures and training requirements through RACS. May inform future PBS considerations for robotic surgery programs Younger rectal cancer patients (≤65 years) suitable for minimally invasive low anterior resection in centres with robotic capability

Abstract

Robotic low anterior resection (R-LAR) has been proposed to overcome technical limitations of laparoscopy in rectal surgery. However, previous meta-analyses have evaluated mixed-age populations, and no meta-analysis has specifically investigated younger patients (aged < 65 years) undergoing low anterior resection. This study aimed to compare operative, short-term postoperative, and oncological outcomes between robotic and laparoscopic low anterior resection in this cohort. A systematic review and meta-analysis were conducted according to PRISMA 2020 and the Cochrane Handbook, with prospective registration in Prospero. PubMed, Scopus, and the Cochrane Library were searched up to January 2026. Comparative studies evaluating R-LAR versus L-LAR in younger rectal cancer cohorts, defined as studies with mean patient age ≤ 65 years, were included. Random-effects models were used to calculate pooled mean differences (MD), odds ratios (OR), and hazard ratios (HR) with 95% confidence intervals (CI). Risk of bias was assessed using ROBINS-I and RoB2, and certainty of evidence using GRADE. A total of 16 studies were included. Compared with laparoscopy, R-LAR was associated with longer operative duration (MD 24.59 min, 95% CI 3.85-45.33, p = 0.02, I² = 96%), lower conversion to open surgery (OR 0.38, 95% CI 0.27-0.53, p < 0.0001, I² = 38%), lower overall complications (OR 0.84, 95% CI 0.73-0.97, p = 0.02, I² = 0%), lower 30-day mortality (OR 0.59, 95% CI 0.45-0.77, p = 0.006, I² = 0%), lower 30-day reoperation (OR 0.77, 95% CI 0.61-0.98, p = 0.04, I² = 0%), higher complete TME rates (OR 3.30, 95% CI 2.14-5.10, p = 0.003, I² = 0%) and shorter hospital stay (MD -0.82, 95% CI -1.50 to -0.13, p = 0.02, I²=97%). Estimated blood loss (p = 0.05) and major complications (p = 0.05) were borderline significant in favor of R-LAR. Anastomotic leakage (p = 0.17), postoperative ileus (p = 0.49), time to first flatus (p = 0.12), time to diet initiation (p = 0.10), CRM positivity (p = 0.56), lymph node yield (p = 0.09), local recurrence (p = 0.67), loop ileostomy (p = 0.56), disease-free survival (p = 0.53), and overall survival (p = 0.73) were comparable. The certainty of evidence ranged from very low to moderate. Functional outcomes were insufficient for pooling. Robotic low anterior resection in younger rectal cancer cohorts may improve several perioperative and technical outcomes without compromising oncological adequacy. Further high-quality studies are required to confirm these findings.

References

1. 1.Kossenas, K., Patsouras, D., Dimitroulis, D., Schizas, D., Doudakmanis, C., Giannakopoulos, K., Konstantinidis, M., Lymperis, I., & Nikiteas, N. (2026). Perioperative and oncological outcomes of robotic versus laparoscopic low anterior resection in younger rectal cancer cohorts: a systematic review and meta-analysis with narrative functional assessment. Journal of Robotic Surgery. https://doi.org/10.1007/s11701-026-03336-2