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Background <p>Evidence of superiority of robotic-assisted surgery for colorectal resections remains limited. This systematic review and meta-analysis aims to compare robotic-assisted and laparoscopic surgical techniques in high-risk patients undergoing resections for colorectal cancer.</p> Methods <p>Systematic searches were performed using Pubmed, Embase and Cochrane library databases from inception until December 2024. Randomised and non-randomised studies reporting outcomes of robotic-assisted or laparoscopic resections in the following high-risk categories were included: obesity, male gender, the elderly, low rectal cancer, neoadjuvant chemoradiotherapy and previous abdominal surgery. Comparative meta-analyses for all sufficiently reported outcomes were completed. Risk of bias was assessed using the ROBINS-I and RoB&#xa0;2 tools for non-randomised and randomised studies, respectively.</p> Results <p>48 studies, including a total of 34,846 patients were eligible for inclusion and 32 studies were utilised in the comparative meta-analyses. Conversion&#xa0;to&#xa0;open rates were significantly lower for robotic-assisted surgery in patients with obesity, male patients and patients with low rectal tumours (obese OR 0.41 [CI 0.32–0.51], <i>p</i> &lt; 0.00001); male gender (OR 0.28 [CI 0.22–0.34], <i>p</i> &lt; 0.00001); low tumours OR 0.10 [CI 0.02–0.58], <i>p</i> = 0.01). Length of stay was significantly reduced for robotic-assisted surgery in patients with obesity (SMD&#xa0;0.25 [CI −&#xa0;0.41 to −&#xa0;0.09], <i>p</i> = 0.002). Operative time was significantly longer in all subgroups (obesity SMD 0.57 [CI 0.31–0.83], <i>p</i> &lt; 0.0001; male gender SMD 0.77 [CI 0.17–1.37], <i>p</i> = 0.01; elderly SMD 0.50 [CI 0.18–0.83], <i>p</i> = 0.002; low rectal tumours SMD 0.48 [CI 0.12–0.84], <i>p</i> = 0.008; neoadjuvant chemoradiotherapy SMD 0.72 [CI 0.34–1.09], <i>p</i> = 0.0002; previous surgery SMD 1.55 [CI 0.05–3.06], <i>p</i> = 0.04). When calculable, blood loss, length of stay, complication rate and lymph node yield were comparable in all subgroups.</p> Conclusions <p>This review provides further evidence of non-inferiority of robotic-assisted surgery for colorectal cancer and demonstrates conversion rates are superior in specific, technically challenging operations.</p>

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Robotic-assisted versus laparoscopic surgery for colorectal cancer in high-risk patients: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月8日

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  • S. Gahunia,
  • J. Wyatt,
  • S. G. Powell,
  • S. Mahdi,
  • S. Ahmed,
  • K. Altaf

摘要

Background

Evidence of superiority of robotic-assisted surgery for colorectal resections remains limited. This systematic review and meta-analysis aims to compare robotic-assisted and laparoscopic surgical techniques in high-risk patients undergoing resections for colorectal cancer.

Methods

Systematic searches were performed using Pubmed, Embase and Cochrane library databases from inception until December 2024. Randomised and non-randomised studies reporting outcomes of robotic-assisted or laparoscopic resections in the following high-risk categories were included: obesity, male gender, the elderly, low rectal cancer, neoadjuvant chemoradiotherapy and previous abdominal surgery. Comparative meta-analyses for all sufficiently reported outcomes were completed. Risk of bias was assessed using the ROBINS-I and RoB 2 tools for non-randomised and randomised studies, respectively.

Results

48 studies, including a total of 34,846 patients were eligible for inclusion and 32 studies were utilised in the comparative meta-analyses. Conversion to open rates were significantly lower for robotic-assisted surgery in patients with obesity, male patients and patients with low rectal tumours (obese OR 0.41 [CI 0.32–0.51], p < 0.00001); male gender (OR 0.28 [CI 0.22–0.34], p < 0.00001); low tumours OR 0.10 [CI 0.02–0.58], p = 0.01). Length of stay was significantly reduced for robotic-assisted surgery in patients with obesity (SMD 0.25 [CI − 0.41 to − 0.09], p = 0.002). Operative time was significantly longer in all subgroups (obesity SMD 0.57 [CI 0.31–0.83], p < 0.0001; male gender SMD 0.77 [CI 0.17–1.37], p = 0.01; elderly SMD 0.50 [CI 0.18–0.83], p = 0.002; low rectal tumours SMD 0.48 [CI 0.12–0.84], p = 0.008; neoadjuvant chemoradiotherapy SMD 0.72 [CI 0.34–1.09], p = 0.0002; previous surgery SMD 1.55 [CI 0.05–3.06], p = 0.04). When calculable, blood loss, length of stay, complication rate and lymph node yield were comparable in all subgroups.

Conclusions

This review provides further evidence of non-inferiority of robotic-assisted surgery for colorectal cancer and demonstrates conversion rates are superior in specific, technically challenging operations.