Comparison of surgical outcomes between robotic and laparoscopic surgery for mid-low rectal cancer: a meta-analysis of randomized controlled trials.

The surgical treatment of mid-low rectal cancer poses greater technical challenges, and whether robotic surgery provides superior safety and efficacy compared to laparoscopic surgery remains controversial. The aim of this meta-analysis was to compare the surgical outcomes of robotic and laparoscopic surgery for mid-low rectal cancer. We searched the PubMed, Cochrane, and Web of Science databases for randomized controlled trials (RCTs) comparing robotic and laparoscopic surgery for mid-low rectal cancer, published up to November 30, 2024. A total of four RCTs were finally included, comprising 1952 patients with mid-low rectal cancer. For patients with mid-low rectal cancer, robotic surgery was associated with longer operative time, a lower rate of conversion to open surgery, a higher lymph node yield, a lower rate of positive circumferential resection margin, and a lower rate of reoperation within 30 days postoperatively compared with laparoscopic surgery. However, there were no significant differences between the two surgical approaches in the estimated blood loss, the postoperative hospital stay, the rates of overall and severe postoperative complications, the time to first autonomous urination and to first flatus, and the rate of readmission within 30 days postoperatively between the two surgical approaches. Robotic surgery demonstrated certain advantages in reducing conversion rates and improving pathological outcomes for mid-low rectal cancer, but its clinical superiority remains limited, with no significant differences observed in multiple critical clinical outcomes compared with laparoscopic surgery, along with prolonged operative time. These findings indicate that, for mid-low rectal cancer, robotic surgery is a technically more refined option but does not confer absolute advantages over laparoscopic surgery.