Robotic versus laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of randomized trials evaluating functional recovery, complication risk, and oncologic quality.

Robotic colorectal surgery (RCS) offers enhanced dexterity and visualization, potentially improving oncologic and perioperative outcomes compared to laparoscopic colorectal surgery (LCS). However, its comparative benefits remain unclear. This systematic review and meta-analysis, registered in PROSPERO (CRD420251036097), evaluated randomized controlled trials comparing RCS and LCS for colorectal cancer. The primary outcomes were time to bowel function, major complications, and total mesorectal excision (TME) completeness. Secondary outcomes included operative time, blood loss, lymph node yield, conversion to open surgery, hospital stay, anastomotic leakage, CRM involvement, and R0 resection. The meta-analysis incorporated seven randomized controlled trials involving 1731 patients: 869 underwent robotic-assisted surgery, while 862 underwent conventional laparoscopy. Robotic surgery significantly improved time to bowel function (MD - 0.62 days), reduced major complications (OR 0.70), and lowered conversion rates (OR 0.27) and CRM involvement (OR 0.62) compared to laparoscopy. Operative time was longer (MD + 22.7 min), while laparoscopic surgery yielded slightly higher lymph node counts (MD + 0.53). No significant differences were found in TME completeness, R0 resection, or anastomotic leaks. RCS has meaningful advantages in bowel recovery, surgical precision, and intraoperative outcomes, supporting its broader adoption in the surgical management of colorectal cancer.