SynthesisSurgical endoscopy2026
Robot-assisted versus laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of randomised trials with GRADE certainty rating.
Synthesis in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
0 citing papers in PubMed.
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Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRobot-assisted rectal cancer surgery is being adopted rapidly, yet prior meta-analyses have emphasised intermediate endpoints and have not rated the certainty of evidence. We compared the two approaches using a strictly randomised evidence base, with formal certainty rating and robustness testing.
methodsWe searched PubMed/MEDLINE, Embase and Cochrane CENTRAL from inception to 28 March 2026 for randomised controlled trials. Pre-specified primary outcomes were total operative time and major complications (Clavien-Dindo grade ≥ III). Outcomes were pooled using random-effects models with restricted maximum likelihood estimation and Hartung-Knapp-Sidik-Jonkman confidence intervals; risk of bias was assessed per outcome (RoB 2) and certainty rated with GRADE (PROSPERO CRD420261383724).
resultsSeven independent trials (2,540 patients) were synthesised. Robot-assisted surgery was associated with longer operative time (MD 39.8 min, 95% CI 4.4 to 75.3) and fewer conversions (OR 0.52, 0.30 to 0.91), with no difference in major complications (OR 0.69, 0.36 to 1.31). Estimates favouring robot-assisted surgery for circumferential margin positivity (OR 0.62, 0.37 to 1.05) and complete mesorectal excision (OR 1.47, 0.92 to 2.36) were not significant and attenuated when the largest trial was excluded. Disease-free and overall survival did not differ. Certainty was low or very low throughout. One trial judged robot-assisted surgery not cost-effective; none reported environmental outcomes.
conclusionsCurrent randomised evidence does not establish clear overall superiority of robot-assisted over laparoscopic rectal cancer surgery, despite fewer conversions, and indicates higher direct costs where reported. These largely confirmatory findings suggest outcomes depend more on patient and surgeon factors than on the platform.
trial registrationPROSPERO (CRD420261383724).
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