Background. Robotic surgery has been recently used as a novel tool for rectal surgery. This study assessed the current evidence regarding the efficiency, safety, and potential advantages of robotic rectal surgery (RRS) compared with laparoscopic rectal surgery (LRS). Methods. We comprehensively searched PubMed, Embase, and the Cochrane Library databases and performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs) assessing the 2 approaches. Results. Seven RCTs including a total of 1022 cases were identified. The conversion rate is significantly lower for RRS (odds ratio: 0.29; 95% confidence interval: 0.09 to 0.96; P = .04). The length of the distal margin was significantly shorter in the LRS group than in the RRS group (weighted mean difference: 0.60; 95% confidence interval: 0.09 to 1.10; P = .02). Perioperative complication rates, harvested lymph nodes, positive circumferential resection margins, complete total mesorectal excision, first flatus, and length of stay did not differ significantly between approaches (P > .05). Conclusions. This meta-analysis indicates that RRS is a safe and effective approach. It is not inferior to LRS in terms of oncologic outcomes and postoperative complications. Future large-volume, well-designed RCTs with extensive follow-up are awaited to confirm and update the findings of this analysis.
IversenLHNørgaardMJepsenP, et al. Trends in colorectal cancer survival in Northern Denmark: 1985-2004. Colorectal Dis. 2007;9:210-217.
2.
PramateftakisMGKanellosDTekkisPPTouroutoglouNKanellosI.Rectal cancer: multimodal treatment approach. Int J Surg Oncol. 2012;2012:279341.
3.
KangSBParkJWJeongSY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 2010;11:637-645.
4.
DenoyaPWangHSandsDNoguerasJWeissEWexnerSD.Short-term outcomes of laparoscopic total mesorectal excision following neoadjuvant chemoradiotherapy. Surg Endosc. 2010;24:933-938.
5.
SaraSPoncetGVoirinDLaverriereMHAngladeDFaucheronJL.Can adequate lymphadenectomy be obtained by laparoscopic resection in rectal cancer? Results of a case-control study in 200 patients. J Gastrointest Surg. 2010;14:1244-1247.
6.
LeroyJJamaliFForbesL, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc. 2004;18:281-289.
7.
GuillouPJQuirkePThropeH, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718-1726.
8.
SammourTKahokehrASrinivasaSBissettIPHillAG.Laparoscopic colorectal surgery is associated with a higher intraoperative complication rate than open surgery. Ann Surg. 2011;253:35-43.
9.
BalchGC.Emerging role of laparoscopic and robotic surgery for rectal cancers. Ann Surg Oncol. 2009;16:1451-1453.
10.
PigazziAGarcia-AguilarJ.Robotic colorectal surgery: for whom and for what?Dis Colon Rectum. 2010;53:969-970.
11.
RashidTGKiniMIndTE.Comparing the learning curve for robotically assisted and straight stick laparoscopic procedures in surgical novices. Int J Med Robot. 2010;6:306-310.
12.
CuiYLiCXuZ, et al. Robot-assisted versus conventional laparoscopic operation in anus-preserving rectal cancer: a meta-analysis. Ther Clin Risk Manag. 2017;13:1247-1257.
13.
YangYWangFZhangP, et al. Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol. 2012;19:3727-3736.
14.
LiaoGZhaoZLinS, et al. Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials. World J Surg Oncol. 2014;12:122.
15.
ClarkHDWellsGAHuëtC, et al. Assessing the quality of randomized trials: reliability of the Jadad Scale. Control Clin Trials. 1999;20:448-452.
16.
HozoSPDjulbegovicBHozoI.Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13.
17.
BaikSHKwonHYKimJS, et al. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol. 2009;16:1480-1487.
18.
PatritiACeccarelliGBartoliASpazianiABiancafarinaACasciolaL.Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS. 2009;13:176-183.
19.
JayneDPigazziAMarshallH, 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;318:1569-1580.
20.
KimMJParkSCParkJW, et al. Robot-assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial. Ann Surg. 2018;267:243-251.
21.
TolstrupRFunderJALundbechbLThomassenNIversenLH.Perioperative pain after robot-assisted versus laparoscopic rectal resection. Int J Colorectal Dis. 2018;33:285-289.
22.
WangGWangZJiangZLiuJZhaoJLiJ.Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer. Int J Med Robot. 2017;13:e1725.
23.
DebakeyYZaghloulAFaragAMahmoudAElattarI.Robotic-assisted versus conventional laparoscopic approach for rectal cancer surgery, First Egyptian Academic Center Experience, RCT. Minim Invasive Surg. 2018;2018:5836562.
24.
SuttonAJDuvalSJTweedieRLAbramsKRJonesDR.Empirical assessment of effect of publication bias on meta-analyses. BMJ. 2000;320:1574-1577.
25.
HuangYJKangYNHuangYMWuATWangWWeiPL. Effects of laparoscopic vs robotic-assisted mesorectal excision for rectal cancer: an update systematic review and meta-analysis of randomized controlled trials [published online January 2, 2019]. Asian J Surg. doi:10.1016/j.asjsur.2018.11.007
26.
BaekSJKimSHChoJSShinJWKimJ.Robotic versus conventional laparoscopic surgery for rectal cancer: a cost analysis from a single institute in Korea. World J Surg. 2012;36:2722-2729.
27.
PatelCBRagupathiMRamos-ValadezDIHaasEM.A three-arm (laparoscopic, hand-assisted, and robotic) matched-case analysis of intraoperative and postoperative outcomes in minimally invasive colorectal surgery. Dis Colon Rectum. 2011;54:144-150.
28.
RodriguezRMJDiaz PavonJMde La Portilla de JuanFSilleroEPDussortJMHCPadilloJ. Prospective randomised study: robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection [in Spanish]. Cir Esp. 2011;89:432-438.
PhanKKahlaeeHRKimSHTohJWT. Laparoscopic vs robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies [published online January 8, 2019]. Tech Coloproctol. doi:10.1007/s10151-018-1920-0
31.
ClancyCO’LearyDPBurkeJP, et al. A meta-analysis to determine the oncological implications of conversion in laparoscopic colorectal cancer surgery. Colorectal Dis. 2015;17:482-490.
32.
ChanACPoonJTFanJKLoSHLawWL. Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer. Surg Endosc. 2008;22:2625-2630.
33.
RottoliMBonaSRosatiR, et al. Laparoscopic rectal resection for cancer: effects of conversion on short-term outcome and survival. Ann Surg Oncol. 2009;16:1279-1286.
34.
KimJYKimNKLeeKYHurHMinBSKimJH.A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol. 2012;19:2485-2493.
35.
ParkSYChoiGSParkJSKimHJRyukJPYunSH.Urinary and erectile function in men after total mesorectal excision by laparoscopic or robot-assisted methods for the treatment of rectal cancer: a case-matched comparison. World J Surg. 2014;38:1834-1842.
