Outcomes of Laparoscopic Versus Robotic-assisted Surgery for Colorectal Cancer: A systematic Review and Meta-analysis

Abstract

Background: Laparoscopic (LCS) and robotic-assisted colorectal surgery (RACS) are commonly utilized minimally invasive procedures for colorectal cancer (CRC). However, their comparative effectiveness remains debated. This systematic review and meta-analysis examined short-term outcomes between LCS and RACS to support clinical decision-making.

Methods: A systematic search of PubMed, Cochrane Library, Science Direct, and Web of Science was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. Fifteen studies (n=15) comparing LCS and RACS in CRC patients were included. Primary outcomes were operation time and hospital length of stay (LOS). Secondary outcomes post-operative complications. Data were pooled using random-effects models, with heterogeneity measured via I² statistics.

Results: Concerning operative Time, RACS required considerably longer operations than LCS (SMD: -0.68, 95% CI: -1.09 to -0.28; I²=92.6%). RACS revealed a small but substantial reduction in LOS (SMD: 0.3, 95% CI: 0.11–0.48; I²=96%). LCS had fewer overall complications (RR: 0.78, 95% CI: 0.62–0.97), including decreased anastomotic leak (RR: 0.80) and readmission rates (RR: 0.87). RACS was consistently more expensive, with 50% greater costs in some studies.

Conclusions: LCS is the standard minimally invasive method due to its shorter surgical times, lower costs, and comparable—or superior—safety profile. RACS may assist specific patients (e.g., difficult pelvic dissections) but lacks wide advantages to support frequent use. Further randomized trials are needed to identify their ideal role.