Urological and sexual function after robotic and laparoscopic surgery for rectal cancer: A systematic review, meta-analysis and meta-regression

Background: This systematic review sought to compare the urogenital functions after laparoscopic (LAP) and robotic (ROB) surgery for rectal cancer. Methods: This study conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Twenty-six studies (n = 2709 for ROB, n = 2720 for LAP) were included. There was a lower risk of 30-day urinary retention in the ROB group (risk ratios 0.78, 95% confidence interval [CI] 0.61–0.99), but the long-term risk was comparable (p = 0.460). Meta-regression showed a small, positive relationship between age and risk of 30-day urinary retention in both the ROB (p = 0.034) and LAP groups (p = 0.004). The International Prostate Symptom Score was better in the ROB group at 3 months (mean difference [MD] −1.58, 95% CI −3.10 to −0.05). The International Index of Erectile Function score was better in the ROB group at 6 months (MD 4.06, 95% CI 2.38 – 5.74). Conclusion: While robotics may improve urogenital function after rectal surgery, the quality of evidence is low based on the Grading of Recommendations, Assessment, Development and Evaluation approach.