Clinical outcomes of robotic versus laparoscopic colorectal surgery during the early learning curve: a systematic review and meta-analysis

Abstract

Surgery is a cornerstone for colorectal cancer treatment. Though laparoscopy surgery is a well-established technique for colorectal patients and has shown reduced hospital stay and postoperative morbidities, it has inherent limitations due to straight instruments and limited views in areas such as the pelvis. Nevertheless, recently, the robotic approach has aimed to overcome the limitations of laparoscopic techniques and offers EndoWrist technology with 3D, high definition, and stable views for precise dissection. This review aims to compare the clinical outcomes of laparoscopic and robotic surgery for colorectal cancer during the initial adoption phase of robotic techniques. A comprehensive literature search was conducted according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines, resulting in the inclusion of six randomized controlled trials (RCTs) and 17 observational studies. Eligibility criteria focused on adult patients undergoing elective resection for colorectal neoplasia. A total of 23 articles were analyzed for various outcomes. Robotic surgery demonstrated a shorter postoperative hospital stay compared to laparoscopic surgery (MD = −0.132; p = 0.031) and significantly lower conversion to open surgery (OR = 1.480; 95% CI: 0.364-0.635; p = 0.000). No significant difference was observed in 30-day mortality, early postoperative complications, readmission, and reoperation rates between the two groups. Emerging evidence suggests that, during the early adoption phase, robotic surgery for colorectal cancer is associated with reduced conversion rates to open surgery and shorter postoperative hospital stays compared to laparoscopic surgery. However, comprehensive evaluation through future studies is required to elucidate long-term outcomes, cost-effectiveness, and patient-reported measures related to robotic colorectal surgery.