Meta-analysis and trial sequential analysis of robotic versus laparoscopic total mesorectal excision in management of rectal cancer

Robotic or laparoscopic surgery for rectal cancer - which is the best answer? A comprehensive review of oncological outcomes

“…The three RCTs examined in this review by Jayne et al [10] , Kim et al [11] , and Baik et al [12] reported no difference in proximal resection margins when comparing robotic to laparoscopic rectal cancer operations. None of the meta-analyses examined in this review reported a difference in proximal margins [13,14,27,28] . Distal Resection Margin: The ROLARR RCT did not compare length of distal margin between the two surgical groups but did note one patient had a positive distal margin in the laparoscopic group [10] .…”

“…Kim et al [11] also found similar CRM positivity rates in their RCT with no difference in robotic (6.1%) compared to laparoscopic (5.5%) (P = 0.999). Eltair et al [13] also confirmed no difference in positive CRM in their pooled analysis of three RCTs in their meta-analysis, but high heterogeneity was noted (I 2 = 57%). Several meta-analyses that included retrospective studies along with the available RCTs have also shown no difference in positive CRM [14,[24][25][26] .…”

“…A recent meta-analysis by Eltair et al [13] assessed the robotic and. laparoscopic approaches for the treatment of rectal cancer within nine RCTs that included 1463 patients (728 robotic vs. 735 laparoscopic) [13] . Four RCTs were included in the macroscopic assessment of complete TME, including the three discussed above.…”

“…Multiple meta-analyses examining the highest level of evidence available in the form of RCTs have found no difference in the number of lymph nodes retrieved when comparing laparoscopic and robotic surgery for rectal cancer [13][14][15]24,25] .…”

“…Baik et al [12] also noted no difference in mean or median distal resection margins in their groups (P = 0.467). Eltair et al [13] examined five RCTs, which included 455 patients, in their meta-analysis for distal resection margins and found slightly longer distal margins in the robotic group compared to the laparoscopic one with a mean difference of 0.8 cm (P = 0.004). There was significantly high heterogeneity (I 2 = 75%) observed in this pooled analysis.…”