Robot-assisted versus laparoscopic surgery for rectal cancer: A systematic review and meta-analysis

Abstract

Aim: This study aimed to compare clinical and oncological outcomes of robot-assisted and laparoscopic surgery for rectal cancer.

Materials and methods: We searched PubMed/Medline, Embase, the Cochrane Library, Yahoo, and Google Scholar databases for relevant articles published up to 2017. Studies based on comparability between robot-assisted and laparoscopic surgery for rectal cancer were designated. Clinical outcomes included operative time, conversion to open surgery, estimated blood loss (EBL), bowel function recovery time, length of hospital stay (LOS), anastomosis leak, and postoperative complications. Oncological outcomes comprised the number of lymph nodes extracted, the positive circumferential margin (PCRM), and the distal resection margin (DRM).

Results: Twenty studies were designated totaling 5496 patients, comprising a robot-assisted surgery patient group (n = 2168, 39.4%) and a laparoscopic surgery patient group (n = 3328, 60.6%). The robot-assisted surgery group was associated with longer operative time (odds ratio [OR] 0.48, 95% confidence interval [CI]; 0.14, 0.82), lower conversion to open surgery rate (OR 0.55, 95% CI; 0.44, 0.69), shorter LOS (OR - 0.15, 95% CI; -0.30, 0.00), faster bowel function recovery (OR - 0.38, 95% CI; -0.74, -0.02), and lower postoperative complications (OR 0.79, 95% CI; 0.65, 0.97). EBL, anastomosis leak rate, and oncological outcomes including the number of lymph nodes extracted, the DRM, and the PCRM showed no significant differences between groups.

Conclusion: Robot-assisted surgery for rectal cancer showed longer operative time, lower conversion, faster bowel function recovery rates, and shorter hospital stay, and similar oncological outcomes compared to laparoscopic surgery.

Keywords: Laparoscopic surgery; meta-analysis; rectal cancer; robot-assisted.