The role of robotic-assisted surgery in the management of rectal cancer: a systematic review and meta-analysis.

Abstract

Rectal cancer poses a significant global health burden. There is a lack of concrete evidence concerning the benefits of robotic-assisted surgery (RAS) for rectal cancer surgery as compared to laparoscopic and open techniques. To address this gap, we conducted a meta-analysis to assess the intraoperative, postoperative, and safety outcomes of robotic surgery in this context. MEDLINE, Scopus, and the Cochrane library were searched till May 2023 for randomized and non-randomized studies comparing robotic surgery with either laparoscopic or open approach for rectal cancers. The outcomes of interest were operative time, blood loss, harvested lymph nodes, conversion rate, postoperative hospital stay, survival to hospital discharge, urinary retention rate, and anastomotic leakage rate. A random-effects meta-analysis was performed to pool means and dichotomous data to derive weighted mean differences and odds ratios, respectively. A total of 56 studies were shortlisted after the study selection process with a total of 25,458 rectal cancer patients. From the intraoperative outcomes, RAS was significantly associated with an increased operative time (WMD: 41.04, P <0.00001), decreased blood loss (WMD: -24.56, P <0.00001), decreased conversion rates (OR: 0.39, P <0.00001), lesser stay at the hospital (WMD: -1.93, P <0.00001), and no difference was found in lymph nodes harvested. Similarly, RAS group had a significantly greater survival to hospital discharge (OR: 1.90, P =0.04), decreased urinary retention rate (OR: 0.59, P =0.002), and no difference was seen in anastomotic leakage rate. Robotic-assisted surgery (RAS) demonstrates favourable outcomes for rectal cancer patients, contributing to global prevention and control efforts, health promotion, and addressing non-communicable disease risk factors. Further research and public awareness are needed to optimize RAS utilization in this context.