Comparison of Non-Oncological Postoperative Outcomes Following Robotic and Laparoscopic Colorectal Resection for Colorectal Malignancy: A Systematic Review and Meta-Analysis

Abstract

The objective of this systematic review and meta-analysis is to compare the postoperative outcomes of robotic and laparoscopic colorectal resection for colorectal malignancy. We performed a systematic review using a comprehensive search strategy on several electronic databases (PubMed, PubMed Central, Medline, and Google Scholar) in April 2022. Postoperative outcomes of robotic versus laparoscopic surgery for colorectal cancer were compared using 12 end points. Observational studies, randomized controlled trials, and nonrandomized clinical trials comparing robotic and laparoscopic resection for colorectal cancer were included. The statistical analysis was performed using the risk ratio (RR) for categorical variables and the standardized mean differences (SMD) for continuous variables. Sixteen studies involving 2,318 patients were included. The difference in length of hospital stay was significantly shorter with robotic access (SMD = -0.10, 95% CI = -0.19, -0.01, P = 0.04, I 2 = 0%). Regarding intra-abdominal abscesses, the analysis showed an advantage in favor of the robotic group, but the result was not statically significant (RR = 0.54, 95% CI = 0.28, 1.05, P = 0.07, I 2 = 0%). Mechanical obstruction was found to be higher in robotic group, favoring laparoscopic access, but was not significant (RR = 1.91, 95% CI = 0.95, 3.83, P = 0.07, I 2 = 0%). There was no difference in time to pass flatus and consume a soft diet. The rates of anastomotic leakage, ileus, wound infection, readmission, mortality, and incisional hernias were similar with both approaches. Robotic surgery for colorectal cancer is associated with a shorter hospital stay, with no differences in mortality and postoperative morbidity.

Comparison of robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection: a systemic review and meta-analysis of randomized controlled trials

“…However, previous studies comparing the clinical outcomes of RACS with LACS has not been sufficient to prove the benefits of RACS. Some of previous reviews and meta-analysis included non-randomized and observational studies in the meta-analysis which posed a risk of bias ( 23 , 25 , 38 ). Another meta-analysis included only RCTs, but only six studies was selected, leading to a relatively small number of patients and limited outcomes ( 24 ).…”

“…Systemic reviews and meta-analysis had been performed to compare RACS and LACS.A meta-analysis showed that the two methods had similar clinical outcomes ( 23 ), but other meta-analysis declared that RACS had advantages regarding surgical efficacy and morbidity compared to LACS ( 24 , 25 ). However, due to the shortage of strict inclusion criteria, a large amount of low evidence level RACS studies such as retrospective studies was included in above studies, which might resulted in probably unreliable conclusions.…”

A Comparison of Clinical Outcomes of Robot-Assisted and Conventional Laparoscopic Surgery

“…Twenty-three reviews on colectomy were included [30,31,37,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58]. Of the twentythree reviews, two were systematic reviews [30,57], eighteen were meta-analyses [31,37,39,40,[42][43][44][45][46][47][49][50][51][52][53]55,56,58], and three were network meta-analyses [41,48,54]. The corrected covered area of the 23 reviews was 2.6% (slight overlap).…”

“…Within colectomy, multiple indications for surgery and surgical procedures exist. Regarding the indications for surgery, thirteen reviews included colorectal cancer surgery studies only [30,31,41,[43][44][45][46][47][48]54,55,57,58], two reviews focused on resections indicated by diverticular diseases [39,42], and the remaining seven reviews included studies related to colectomy for any or multiple indications [37,40,[49][50][51][52][53]. As for the surgical procedures themselves, nine studies focused on left or right hemicolectomy [50][51][52][53][54][55][56][57][58], four on total mesorectal excisions [31,[46][47][48], two on complete mesocolic excisions [30,45], three on colorectal resections [41,43,44], two on diverticular resections [39,42], and three on multiple surgical procedures related to the colon [37,40,49]<...…”

“…RALS has been proven to achieve comparable clinical results to CLS; however, there are two important drawbacks associated with RALS: the increased expenses of RALS and the increased operative time. Many of the included reviews emphasized that RALS is more expensive than CLS [31,[33][34][35][36][37]42,44,46,49,[51][52][53][54][55]59,[69][70][71][74][75][76][77]. The substantially higher costs are hard to justify as the clinical outcomes barely showed any significant advantages compared to CLS.…”