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

Clinical Snapshot

Key Findings

• P Value: p < 0.00001

• Effect Size: OR 0.45 for conversion rate favouring robotic surgery

• Primary Outcome: Conversion rate significantly lower with robotic approach

• Nnt Or Sensitivity: Assuming 10% baseline conversion rate, NNT = 12 to prevent one conversion

• Confidence Interval: 95% CI 0.40-0.51

Clinical Application

Limited by robotic system availability, surgeon training requirements, and increased operative time Relevant to major Australian colorectal centres with da Vinci systems. Consider PBS funding implications for longer operative times and equipment costs. Aligns with RACS guidelines for minimally invasive colorectal surgery Patients with rectal cancer suitable for minimally invasive low anterior resection in centres with robotic capability

Abstract

Robotic surgery has increasingly been adopted for the treatment of rectal cancer. However, most previous meta-analyses included heterogeneous rectal procedures, limiting conclusions specific to low anterior resection. The present study aimed to provide an updated systematic review and meta-analysis comparing robotic versus laparoscopic low anterior resection for rectal cancer. This systematic review and meta-analysis was conducted according to PRISMA guidelines and recommendations from the Cochrane Handbook. PubMed, Scopus, and the Cochrane Library were systematically searched from inception to the most recent date. Comparative studies evaluating robotic low anterior resection (R-LAR) versus laparoscopic low anterior resection (L-LAR) for rectal cancer were included. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. Certainty of evidence was evaluated using the GRADE approach. Thirty-three studies including 82,149 patients were analyzed (R-LAR: 56,290; L-LAR: 25,859). R-LAR was associated with a significantly lower conversion rate (OR 0.45, 95% CI 0.40-0.51, p < 0.00001, I²=28%), lower 30-day reoperation rate (OR 0.86, 95% CI 0.77-0.96, p = 0.01, I²=0%), reduced 30-day mortality (OR 0.65, 95% CI 0.52-0.82, p = 0.002, I²=0%), and higher rate of complete total mesorectal excision (OR 2.71, 95% CI 1.38-5.33, p = 0.01, I²=72%). Operative time was significantly longer in the robotic group (MD + 30.58 min, 95% CI 13.71-47.45, p = 0.001, I²=97%). No significant differences were observed for estimated blood loss, overall complications, major complications, anastomotic leakage, postoperative ileus, recovery parameters, length of hospital stay, readmission, circumferential margin positivity, lymph node yield, local recurrence, diverting ileostomy formation, disease-free survival, or overall survival. Robotic LAR may reduce conversion, reoperation, and short-term mortality and may improve completeness of total mesorectal excision, although operative time is longer. These findings suggest potential technical advantages of R-LAR, but high-quality randomized trials are required to determine whether these translate into meaningful clinical benefit.PROSPERO: CRD420261326600.

References

1. 1.Kossenas, K., Konstantinidis, M., Sakarellos, P., Bitsianis, S., Machairas, N., Kykalos, S., Mantzoros, I., Mpallas, K., & Schizas, D. (2026). Robotic versus laparoscopic low anterior resection for rectal cancer: an updated systematic review and meta-analysis. Journal of Robotic Surgery. https://doi.org/10.1007/s11701-025-03098-3