Effects of laparoscopic vs robotic-assisted mesorectal excision for rectal cancer: An update systematic review and meta-analysis of randomized controlled trials

Background: Controversy still surrounds clinical benefits of robotic-assisted (RS) over laparoscopic surgery (LS) despite its popularity in clinical use in terms of outcomes and complication rates. The study aims to systematically review and provide the evidence concerning the risk of conversion to open laparotomy and oncological outcomes of LS vs RS rectal cancer surgery. Methods: The Cochrane Library (including the Cochrane Central Register of Controlled Trials), EMBASE, PubMed, SCOPUS, and Web of Science were searched for randomized controlled trials (RCTs) comparing LS and RS. Results: Eight RCTs including 1305 patients were identified. Pooled conversion rate was reported in 49 (11.89%) of 412 patients who underwent LS and in 23 (5.72%) of 402 patients who underwent RS (95% CI, 1.357 to 3.613; P =.001). However, shorter operative time was noted in LS group than RS group (95% CI, −43.106 to −3.876; P =.019). No significant difference in other outcomes was observed. Finally, in further analysis, the mean age in trial-level was found to be positively associated with operative time (point estimate = 2.598; 95% CI, 1.584 to 3.612; P <.001) and negatively with length of hospital stay. Conclusions: Robot-assisted surgery in rectal cancer showed lower conversion rate in comparison with that of laparoscopic surgery. Secondly, the laparoscopic surgery has shorter operative time compared with robot-assisted approach. The results also showed similar pathological outcomes between these two modalities. Future studies are needed to clarify the relationship between mean age and outcomes of surgery.