Robotic versus laparoscopic colorectal surgeries: A systematic review and meta-analysis

Abstract

In recent times, there has been a logarithmic rise in the use of robotics in colorectal surgery. The latest systematic review comparing intraoperative and postoperative prognostic factors influencing outcomes between laparoscopic and robotic surgery is lacking. The meta-analysis was done using Preferred Reporting Items for Systematic Review (PRISMA) and Meta-analysis of Observational Studies in Epidemiology and searching Medline, PubMed, and Web of Science published from January 2014 to May 2020. All statistical analysis and data synthesis were conducted using STATA/IC version 14.2 WINDOWS 64 bit (Stata Corp LP College Station, TX, USA). Sixty-four studies published in last 5 years from January 2014 to May 2020 consisting of 74,281 participants comparing laparoscopic versus robot-assisted colorectal surgery were analyzed. Robotic-assisted surgery reported lower conversion to open surgery compared to laparoscopic surgery (P < 0.0001) with a narrow (95% confidence interval: 0.35–0.62). We did not find any significant difference between the two approaches for anastomotic leak (P = 0.599). The mortality rate was significantly higher in laparoscopic surgery (P < 0.002). Postoperative ileus was comparable significantly in robotic surgery (P < 0.577). Length of hospital stay (HS) was similar in both groups (P = 0.058), with lower trends in robotic surgery. Harvested lymph nodes and intraoperative blood loss were similar in both groups. Descriptive cost analysis favored laparoscopic-assisted colorectal surgeries. Intraoperative time was significantly longer for robot-assisted colorectal surgery (P = 0.001). Robotic-assisted colorectal surgery is oncologically safe with less requirement of conversion of open, reduced mortality rate, while anastomotic leak, blood loss, HS, postoperative ileus, and harvested nodes were comparable with laparoscopically assisted colorectal surgery.