Skip to main content
Download PDF

Robotic versus laparoscopic surgery for rectal cancer: an updated systematic review and meta-analysis of randomized controlled trials

BMC Surgery volume 25, Article number: 86 (2025) Cite this article

Abstract

Background

The usage of robotic surgery in rectal cancer was increasing, but there was an ongoing debate as to whether it provided any benefit. The aim of this study was to evaluate the safety, efficacy, and prognosis of elective rectal resection for rectal cancer by robotic surgery compared with conventional laparoscopic surgery.

Method

Electronic databases were searched from their inception to 1 February 2024, for randomized controlled trials (RCTs) involving a comparison between robotic surgery (RS) and laparoscopic surgery (LS) and performed a meta-analysis of all RCTs according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Results

11 RCTs including a total of 3107 cases were identified. Compared with LS, RS had a significantly lower conversion rate (odds ratio: 0.42; 95% confidence interval: 0.28 to 0.63; P < 0.0001), lower reoperation rate (odds ratio: 0.454; 95% confidence interval: 0.31 to 0.94; P = 0.03), more lymph nodes harvested (mean difference: 0.67; 95% confidence interval: 0.30 to 1.04; P = 0.0004), a smaller incidence of positive circumferential margin (CRM) (odds ratio: 0.59; 95% confidence interval: 0.41 to 0.85; P = 0.004). RS had less time to first autonomous urination (mean difference: -0.78; 95% confidence interval: -1.15 to -0.41; P < 0.0001), less time to first defecation (mean difference: -0.40; 95% confidence interval: -0.78 to -0.01; P = 0.04) and less time to first flatus (mean difference: -0.45; 95% confidence interval: -0.89 to -0.01; P = 0.04), more operating time (mean difference: 23.46; 95% confidence interval: 15.76 to 31.16; P < 0.00001). Overall postoperative complication, short-term postoperative complication, estimate blood loss, hospital stays, Intraoperative complication, postoperative mortality, preventive ostomy rates, readmission did not differ significantly between approaches. (P > 0.05).

Conclusion

Compared to laparoscopic surgery, robotic surgery demonstrated superior safety, efficacy, and prognosis. This meta-analysis supports that RS is a safe and effective option.

Peer Review reports

Introduction

Rectal cancer is one of the most common malignancies and represents a significant cause of morbidity and mortality worldwide [1]. Since the advent of minimally invasive techniques in gastrointestinal surgery, both laparoscopic and robotic approaches have witnessed a steady increase in utilization for rectal cancer procedures. The laparoscopic approach has demonstrated superior short-term outcomes and facilitated quicker postoperative recovery when compared to traditional open surgery [2, 3]. However, its application in rectal cancer surgery, particularly for tumors located in the lower rectum, remains challenging due to anatomical constraints. Robotic surgery addresses many of these challenges by offering enhanced 3-D visualization, improved dexterity, reduced tremors, motion scaling, and a shorter learning curve [4,5,6]. While numerous meta-analyses comparing robotic rectal surgery (RS) and laparoscopic rectal surgery (LS) have been conducted, many suffer from small sample sizes, and some yield inconsistent results [7,8,9,10,11,12,13,14,15]. Despite numerous prior meta-analyses comparing RS versus LS, the evidence supporting the superiority of robotic approach over laparoscopy remained inconclusive. Previous systematic reviews and meta-analyses primarily relied on observational comparative studies. However, more recent reports have shifted their focus to a limited number of RCTs with inadequate sample sizes. Therefore, we conducted an extensive literature search and analysis, expanding the sample size to assess the potential advantages of RS versus LS in terms of safety, efficacy, and prognosis.

Method

Design

This meta-analysis of RCTs was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Search strategy

According to the PICOT framework. Patients: Patients with rectal cancer who underwent surgical intervention. Interventions: Robotic rectal surgery. Comparison: Laparoscopic rectal cancer. Outcome: short-term results, quality of surgery and pathological outcomes. Type of study: RCT. PubMed, Embase and the Cochrane Library were searched from their inception to 1 February 2024. The search strategy included the following terms: “robotic”, “laparoscopic”, “rectal carcinoma”, “rectal cancer”, “proctectomy”, “total mesorectal excision”, “randomized”, and “trial”, utilized either as keywords or MeSH terms. The complete search string used for the literature search in PubMed is provided in Appendix S1.

Study selection

Two independent authors (J.Y.Z, H.Y.Z) screened the retrieved articles from the initial literature search, removing duplicate studies and discarding irrelevant ones. Eligibility studies were then further assessed independently by the two authors, either in abstract form or in full text, to determine if they met the inclusion criteria. Any disagreements regarding study selection between the two authors were resolved through discussion and consensus, or by consulting a third independent author (X.J.W).

Fig. 1
figure 1

Study selection diagram for meta-analysis of RS and LS procedures

Full size image

Data collection

Two reviewers (J.Y.Z and H.Y.Z) independently extracted the pertinent data from the included studies, including details such as the first author, publication year, country, characteristics of the study population, gender ratio, and study outcomes. The second author (H.Y.Z) verified all extracted data. In cases of disagreement, a third author (X.J.W) was consulted for resolution.

Risk of bias assessment

Risk of bias was analyzed using the Cochrane risk assessment tool.

Outcomes

The primary outcomes were postoperative complication rates, short-term postoperative complication rates, conversion rates, harvested lymph nodes and positive positive circumferential margin (CRM) rates. The secondary outcomes were intraoperative complication rates, postoperative mortality, preventive ostomy rates, readmission rates, reoperation rates, operative time, estimated blood loss, first flatus, first defecation, first autonomous urination and hospital stays. For each study, patient characteristics were extracted according to availability. For each study, patient characteristics were extracted according to availability. We used postoperative complication rates, short-term postoperative complication rates, conversion rates, intraoperative complication rates, postoperative mortality, and estimated blood loss to assess the safety of the surgery. Harvested lymph nodes, positive CRM rates, operative time, and preventive ostomy rates were used to evaluate the efficacy of the surgery. Readmission rates, reoperation rates, first flatus, first defecation, first autonomous urination, and hospital stays were used to assess the prognosis of the surgery.

Statistical analysis

Continuous variables were pooled using weighted mean difference (WMD) with 95% confidence interval (CI), while odds ratio (OR) with 95% CI was applied to perform the statistical analysis for dichotomous variables. Statistical heterogeneity was evaluated using the χ [2] test with significance set at P < 0.10, and heterogeneity was quantified using the I [2] statistic. This study defined I [2] of 25%, 50%, and 75% as low, moderate, and high heterogeneity, respectively [16]. We utilized a random-effects model for the data analysis procedure when I2 > 40%, as it takes into account the almost inevitable natural variation between studies, particularly in surgical research. P < 0.05 was considered statistically significant. Funnel plots was used to assess publication bias. If the data on continuous outcomes were reported as medians and range or mean and interquartile range, we estimated the mean and standard deviation according to Luo and Wan’s methods [17, 18]. Meta-analysis was conducted by Review Manager Version 5.4. P < 0.05 was considered significant. Through sensitivity analysis conducted by leave-one-out analyses, we sought to gain a deeper understanding of the sources of heterogeneity and strengthen the robustness of the results.

Results

Study selection and characteristics

The study selection process, following the PRISMA guidelines, is illustrated in Fig. 1. Initially, a total of 407 studies were identified. After removing 104 duplicate studies using Endnote software, 264 studies were excluded based on screening of titles and abstracts. Subsequently, eleven studies meeting the inclusion criteria were identified through a thorough full-text evaluation [19,20,21,22,23,24,25,26,27,28,29]. The publication years of these studies ranged from 2008 to 2023, with a cumulative sample size of 3107 participants. The essential characteristics of the included studies and the extracted data are summarized in Table 1.

Table 1 Characteristics of trials included in the meta-analysis
Full size table

Risk of bias assessment

The evaluation results regarding the quality of the study and the risk of bias are depicted in Fig. 2.

Fig. 2
figure 2

The risk-of-bias assessment of each included study

Full size image

Outcomes

The comparison of primary and secondary outcomes between RS and LS is presented in Table 2.

Table 2 Outcomes of comparison between RS and LS
Full size table

Primary outcomes

Pooling the data from 9 studies that assessed overall postoperative complications in 2675 patients showed no significant difference between the RS and LS groups (odds ratio: 0.86; 95% confidence interval: 0.62 to 1.19; P = 0.35) (Fig. 3). 6 studies including 2240 patients reported short-term postoperative complications showed no significant difference between the two groups (odds ratio: 0.92; 95% confidence interval: 0.62 to 1.36; P = 0.67) (Fig. 4). RS had a significantly lower conversion rate in 9 studies included 2614 patients (odds ratio: 0.42; 95% confidence interval: 0.28 to 0.63; P < 0.0001) (Fig. 5), more lymph nodes harvested in 10 studies included 3056 patients (mean difference: 0.67; 95% confidence interval: 0.30 to 1.04; P = 0.0004) (Fig. 6), and a smaller incidence of positive CRM in 6 studies included 2623 patients (odds ratio: 0.59; 95% confidence interval: 0.41 to 0.85; P = 0.004) (Fig. 7).

Secondary outcomes

RS has a lower reoperation rate compared to LS (odds ratio: 0.454; 95% confidence interval: 0.31 to 0.94; P = 0.03) (Fig. 8). less time to first autonomous urination (days) (mean difference: -0.78; 95% confidence interval: -1.15 to -0.41; P < 0.0001) (Fig. 9), less time to first defecation (days) (mean difference: -0.40; 95% confidence interval: -0.78 to -0.01; P = 0.04) (Fig. 10) and less time to first flatus (days) (mean difference: -0.45; 95% confidence interval: -0.89 to -0.01; P = 0.04) (Fig. 11), more operating time(mins) (mean difference: 23.46; 95% confidence interval: 15.76 to 31.16; P < 0.00001) (Fig. 12). intraoperative complication rates, postoperative mortality, preventive ostomy rates, readmission rates, estimated blood loss (ml), and hospital stays (days) did not differ significantly between groups (Fig. 13).

Sensitivity analysis

The analysis results are shown in Appendix S2.

Publication bias

The funnel plots for assessing publication bias for results with at least ten studies are presented in the supplementary material (Figure S1 and S2).

Fig. 3
figure 3

Forest plot of comparison between robotic rectal surgery RS and laparoscopic rectal surgery LS in terms of overall postoperative complications

Full size image
Fig. 4
figure 4

Forest plot of comparison between robotic rectal surgery RS and laparoscopic rectal surgery LS in terms of short-term postoperative complications

Full size image
Fig. 5
figure 5

Forest plot of comparison between robotic rectal surgery RS and laparoscopic rectal surgery LS in terms of conversion rate

Full size image
Fig. 6
figure 6

Forest plot of comparison between robotic rectal surgery RS and laparoscopic rectal surgery LS in terms of lymph nodes harvested

Full size image
Fig. 7
figure 7

Forest plot of comparison between robotic rectal surgery RS and laparoscopic rectal surgery LS in terms of positive CRM

Full size image
Fig. 8
figure 8

Forest plot of comparison between robotic rectal surgery RS and laparoscopic rectal surgery LS in terms of reoperation rate

Full size image
Fig. 9
figure 9

Forest plot of comparison between robotic rectal surgery RS and laparoscopic rectal surgery LS in terms of time to first autonomous urination (days)

Full size image
Fig. 10
figure 10

Forest plot of comparison between robotic rectal surgery RS and laparoscopic rectal surgery LS in terms of time to first defecation (days)

Full size image
Fig. 11
figure 11

Forest plot of comparison between robotic rectal surgery RS and laparoscopic rectal surgery LS in terms of time to first flatus (days)

Full size image
Fig. 12
figure 12

Forest plot of comparison between robotic rectal surgery RS and laparoscopic rectal surgery LS in terms of operating time (mins)

Full size image
Fig. 13
figure 13

Forest plot of comparison between robotic rectal surgery RS and laparoscopic rectal surgery LS in terms of secondary outcomes without statistical significance. (a) Intraoperative complication rates; (b) postoperative mortality; (c) preventive ostomy rates; (d) readmission rates; (e) estimated blood loss (ml); (f) hospital stays (days)

Full size image

Discussion

Improvements in surgical techniques were important in advancing the field of rectal cancer treatment. This study examined the outcomes of robotic surgery versus laparoscopic surgery for rectal cancer based on evidence from RCTs and included 11 RCTs that randomized 3,107 patients into two groups. The sample size in this study was larger than in previous studies. As the sample size increased, the evidence became more robust. RS gained popularity due to its advantages in navigating the narrow pelvic cavity compared to LS [30, 31]. This study aimed to conduct a comprehensive and critical analysis of multi-center and large RCT samples regarding the use of RS, providing valuable evidence for clinical decision-making. Our meta-analysis revealed that the RS group exhibited a lower conversion rate to laparotomy, lower positive CRM rates, increased lymph node harvested, faster postoperative recovery of bowel function, and reduced reoperation rates compared to the LS group. However, the operation time in the RS group was longer. No significant differences were observed between the two groups in terms of postoperative mortality, overall postoperative complications, short-term postoperative complications, readmission rates, intraoperative complications, rates of preventive ostomy, length of hospital stays, and estimated blood loss.

The conversion rate was a significant factor linked to postoperative complications, adverse outcomes, and mortality [32, 33], bearing both short- and long-term clinical relevance in rectal cancer surgery [34, 35]. Previous studies indicated that RS did not have an advantage over LS in terms of the conversion rate [23]. This meta-analysis revealed a significantly lower overall pooled conversion rate in patients who underwent robotic surgery compared to those who underwent laparoscopic surgery.

Previous studies indicated the clinical and physiological superiority of laparoscopic surgery over open surgery [36, 37]. However, our meta-analysis revealed that patients in the RS group did not exhibit a significant difference in length of hospital stay compared to those in the LS group. Interestingly, the RS group demonstrated a significantly shorter time for achieving first autonomous urination, flatus, and defecation compared to the LS group. This suggested that patients who underwent robotic surgery experienced reduced surgical trauma and faster recovery of bowel function compared to those who underwent laparoscopic surgery. A low reoperation rate typically signifies a higher surgical success rate and a reduced occurrence of postoperative complications, making it an important indicator of surgical quality. The increased sample size and inclusion of new RCTs bolstered the statistical power of this meta-analysis. Notably, this study marked the first time that RS demonstrated a lower reoperation rate compared to LS, suggesting superior surgical quality and a favorable prognosis associated with RS.

Limitation

This meta-analysis exclusively comprised randomized controlled trials, and the number of RCTs included was relatively modest. Several RCTs had insufficient data on both primary and secondary endpoints, primarily due to short follow-up durations, and did not address the impact of cost implications. Furthermore, variations in surgical indications, matching criteria, operative techniques, and outcome measurement methods were observed across the included studies, potentially leading to substantial between-study heterogeneity. Pooling of data using the random-effects model cannot completely eliminate the effect of heterogeneity. Future research could address these gaps, including cost-effectiveness and patient-specific benefits (e.g., elderly or anatomically complex cases). this study is the absence of prospective registration on platforms.

Conclusion

This study included the largest number of RCTs comparing RS versus LS to date, making it the largest meta-analysis in terms of sample size, Notably, it is the first investigation to observe a lower reoperation rate for RS compared to LS. Current evidence suggests that RS may offer advantages in surgical quality and recovery. Nevertheless, the longer operating time of surgery and higher cost associated with RS, coupled with the uncertain long-term prognosis, further multicenter and large-scale RCT samples are still needed to confirm our findings.

Data availability

Data is provided within the supplementary information files.

References

  1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–263.

  2. Chen K, Cao G, Chen B, Wang M, Xu X, Cai W, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis of classic randomized controlled trials and high-quality nonrandomized studies in the last 5 years. Int J Surg. 2017;39:1–10.

    Article  PubMed  Google Scholar 

  3. Lim WH, Tan DJH, Ng CH, Syn N, Tai BC, Gu T, et al. Laparoscopic versus open resection for rectal cancer: an individual patient data meta analysis of randomized controlled trials. Eur J Surg Oncol. 2022;48(5):1133–43.

    Article  PubMed  Google Scholar 

  4. Jiménez-Rodríguez RM, de la Díaz-Pavón JM, Prendes-Sillero E, Dussort HC, Padillo J. Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Colorectal Dis. 2013;28(6):815–21.

  5. Kim YW, Lee HM, Kim NK, Min BS, Lee KY. The learning curve for robot-assisted total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutan Tech. 2012;22(5):400–5.

    Article  PubMed  Google Scholar 

  6. Akmal Y, Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A. Robot-assisted total mesorectal excision: is there a learning curve? Surg Endosc. 2012;26(9):2471–6.

    Article  PubMed  Google Scholar 

  7. Han C, Yan P, Jing W, Li M, Du B, Si M, et al. Clinical, pathological, and oncologic outcomes of robotic-assisted versus laparoscopic proctectomy for rectal cancer: a meta-analysis of randomized controlled studies. Asian J Surg. 2020;43(9):880–90.

    Article  PubMed  Google Scholar 

  8. Huang YJ, Kang YN, Huang YM, Wu AT, Wang W, Wei PL. Effects of laparoscopic vs robotic-assisted mesorectal excision for rectal cancer: an update systematic review and meta-analysis of randomized controlled trials. Asian J Surg. 2019;42(6):657–66.

    Article  PubMed  Google Scholar 

  9. Huang YJ, Kang YN, Huang YM, Wu AT, Wang W, Wei PL. Corrigendum to effects of laparoscopic vs robotic-assisted mesorectal excision for rectal cancer: an update systematic review and meta-analysis of randomized controlled trials. [Asian J Surg. 42 (6). 2019 Jun 657–666]. Asian J Surg. 2021;44(1):429.

  10. Li L, Zhang W, Guo Y, Wang X, Yu H, Du B, et al. Robotic versus laparoscopic rectal surgery for rectal cancer: a meta-analysis of 7 randomized controlled trials. Surg Innov. 2019;26(4):497–504.

    Article  PubMed  Google Scholar 

  11. Liao G, Zhao Z, Deng H, Li X. Comparison of pathological outcomes between robotic rectal cancer surgery and laparoscopic rectal cancer surgery: a meta-analysis based on seven randomized controlled trials. Int J Med Robot. 2019;15(5):e2027.

    Article  PubMed  Google Scholar 

  12. Phan K, Kahlaee HR, Kim SH, Toh JWT. Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies. Tech Coloproctol. 2019;23(3):221–30.

    Article  CAS  PubMed  Google Scholar 

  13. Prete FP, Pezzolla A, Prete F, Testini M, Marzaioli R, Patriti A, et al. Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2018;267(6):1034–46.

    Article  PubMed  Google Scholar 

  14. Slim K, Tilmans G, Occéan BV, Dziri C, Pereira B, Canis M. Meta-analysis of randomized clinical trials comparing robotic versus laparoscopic surgery for mid-low rectal cancers. J Visc Surg. 2024;161(2):76–89.

  15. Tang B, Lei X, Ai J, Huang Z, Shi J, Li T. Comparison of robotic and laparoscopic rectal cancer surgery: a meta-analysis of randomized controlled trials. World J Surg Oncol. 2021;19(1):38.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2018;27(6):1785–805.

    Article  PubMed  Google Scholar 

  18. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, et al. Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc. 2008;22(7):1601–8.

    Article  CAS  PubMed  Google Scholar 

  20. Debakey Y, Zaghloul A, Farag A, Mahmoud A, Elattar I. Robotic-assisted versus conventional laparoscopic approach for rectal cancer surgery, first Egyptian Academic Center Experience, RCT. Minim Invasive Surg. 2018;2018:5836562.

    PubMed  PubMed Central  Google Scholar 

  21. Feng Q, Tang W, Zhang Z, Wei Y, Ren L, Chang W, et al. Robotic versus laparoscopic abdominoperineal resections for low rectal cancer: a single-center randomized controlled trial. J Surg Oncol. 2022;126(8):1481–93.

    Article  PubMed  Google Scholar 

  22. Feng Q, Yuan W, Li T, Tang B, Jia B, Zhou Y, et al. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2022;7(11):991–1004.

    Article  CAS  PubMed  Google Scholar 

  23. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA. 2017;318(16):1569–80.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kim MJ, Park SC, Park JW, Chang HJ, Kim DY, Nam BH, et al. Robot-assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial. Ann Surg. 2018;267(2):243–51.

    Article  PubMed  Google Scholar 

  25. Park JS, Lee SM, Choi GS, Park SY, Kim HJ, Song SH, et al. Comparison of laparoscopic versus robot-assisted surgery for rectal cancers: the COLRAR randomized controlled trial. Ann Surg. 2023;278(1):31–8.

    Article  PubMed  Google Scholar 

  26. Tolstrup R, Funder JA, Lundbech L, Thomassen N, Iversen LH. Perioperative pain after robot-assisted versus laparoscopic rectal resection. Int J Colorectal Dis. 2018;33(3):285–9.

    Article  PubMed  Google Scholar 

  27. Wang G, Wang Z, Jiang Z, Liu J, Zhao J, Li J. Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer. Int J Med Robot. 2017;13(1).

  28. Xu J, Wei Y, Ren L, Feng Q, Chen J, Zhu D, et al. Robot-assisted vs laparoscopic vs open abdominoperineal resections for low rectal cancer: short-term outcomes of a single-center prospective randomized controlled trial. Ann Oncol. 2017;28:v161–2.

    Article  Google Scholar 

  29. Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Biancafarina A, Casciola L. Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. Jsls. 2009;13(2):176–83.

    PubMed  PubMed Central  Google Scholar 

  30. Cheng CL, Rezac C. The role of robotics in colorectal surgery. BMJ. 2018;360:j5304.

    Article  PubMed  Google Scholar 

  31. Speicher PJ, Englum BR, Ganapathi AM, Nussbaum DP, Mantyh CR, Migaly J. Robotic low anterior resection for rectal cancer: a national perspective on short-term oncologic outcomes. Ann Surg. 2015;262(6):1040–5.

    Article  PubMed  Google Scholar 

  32. Chan AC, Poon JT, Fan JK, Lo SH, Law WL. Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer. Surg Endosc. 2008;22(12):2625–30.

    Article  PubMed  Google Scholar 

  33. Clancy C, O’Leary DP, Burke JP, Redmond HP, Coffey JC, Kerin MJ, et al. A meta-analysis to determine the oncological implications of conversion in laparoscopic colorectal cancer surgery. Colorectal Dis. 2015;17(6):482–90.

    Article  CAS  PubMed  Google Scholar 

  34. Allaix ME, Furnée EJ, Mistrangelo M, Arezzo A, Morino M. Conversion of laparoscopic colorectal resection for cancer: what is the impact on short-term outcomes and survival? World J Gastroenterol. 2016;22(37):8304–13.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Abdalla S, Lupinacci RM, Genova P, Oberlin O, Goasguen N, Fabiani B, et al. Does conversion during minimally invasive rectal surgery for cancer have an impact on short-term and oncologic outcomes? Results of a retrospective cohort study. Surg Endosc. 2022;36(5):3558–66.

    Article  PubMed  Google Scholar 

  36. Akiyoshi S, Mimori K, Sudo T, Tanaka F, Shibata K, Mori M. Laparoscopic surgery minimizes the surgical manipulation of isolated tumor cells leading to decreased metastasis compared to open surgery for colorectal cancer. Surg Today. 2013;43(1):20–5.

    Article  PubMed  Google Scholar 

  37. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, et al. The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg. 2008;248(1):1–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Not applicable.

Author information

Author notes

  1. Jingyu Zou and Heyuan Zhu contributed equally to this work.

Authors and Affiliations

  1. Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People’s Republic of China

    Jingyu Zou, Heyuan Zhu, Yongqin Tang, Ying Huang, Pan Chi & Xiaojie Wang

Authors
  1. Jingyu Zou
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Heyuan Zhu
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Yongqin Tang
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Ying Huang
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Pan Chi
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Xiaojie Wang
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

JY Zou and HY Zhu collected data and wrote the manuscript, YQ Tang prepared the figures and tables, Y Huang and P Chi provided suggestions for revisions, and XJ Wang provided guidance. All authors reviewed the manuscript.

Corresponding author

Correspondence to Xiaojie Wang.

Ethics declarations

Ethics approval and consent to participate

This study does not require ethics approval.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zou, J., Zhu, H., Tang, Y. et al. Robotic versus laparoscopic surgery for rectal cancer: an updated systematic review and meta-analysis of randomized controlled trials. BMC Surg 25, 86 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12893-025-02805-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12893-025-02805-z

Keywords

BMC Surgery

ISSN: 1471-2482

Contact us