Comparative Systematic Review and Meta-Analysis Between Robotic and Laparoscopic Abdominoperineal Resection for Rectal Cancer: Oncological and Short-Term Outcomes

Abstract

Minimally invasive surgery, especially robotic surgery, has become increasingly popular in colorectal surgery over the last decade. Robotic-assisted surgery has shown better outcomes than conventional laparoscopic surgery because of superior ergonomics, high-resolution three-dimensional cameras, and articulating instruments; however, issues like the long operative time and cost-effectiveness remain unresolved. This study compares the robotic and laparoscopic approach of abdominoperineal resection (APR) for low rectal cancer to evaluate the superiority of robotic surgery in short-term and oncological outcomes.This meta-analysis used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and principles. We conducted a systematic search in the PubMed, Cochrane, Google Scholar, and ResearchGate databases, and seven studies were included after the standardized quality check. Inclusion criteria involved any patient at the age of 18 or above with low rectal cancer who underwent APR with the exclusion of studies that are not in English, patients who underwent open surgery, and patients with recurrent cancer.A total number of 10,331 participants from seven eligible studies were involved in this review and metaanalysis with 1499 in the robotic group and 8,895 in the laparoscopic group. The oncological outcome showed that the positive resection margin is significantly higher in the laparoscopic group with a mean difference (MD) of 0.35, 95% CI (0.14, 0.89), and P = 0.03. The difference in the number of harvested lymph nodes between the robotic and laparoscopic APR is not statistically significant with an OR of 0, 95% CI (-0.19, 0.19), and P = 0.98. The operative time was found to be higher in the robotic group with an MD of 11.25, 95% CI (9.25, 13.04), and P = 0.0001. A higher conversion rate was reported in the laparoscopic group with OR 0.38, 95% CI (0.28, 0.51), and P = 0.00001. The length of the hospital stay was less in the robotic group with an MD of 2, 95% CI (-2.08, -1.92), and P = 0.00001. A lower rate of postoperative ileus was found in the robotic group with an odd ratio of 0.74, 95% CI (0.61,0.89), and P = 0.001, which is statistically significant. The mortality rate and thromboembolic complication also showed a significantly higher rate in the laparoscopic group with an OR of 0.15, 95% CI (0.03, 0.84), and P = 0.03 and an OR of 0.14, 95% CI (0.03, 0.69), and P = 0.02, respectively. There is no statistically significant difference between the robotic and laparoscopic groups in the surgical site infection, urinary dysfunction, cardiac, and pulmonary complications.In conclusion, our study findings indicated that robotic APR has a better short-term outcome and negative circumferential resection margins compared to laparoscopic APR. However, more research and prospective randomized controlled trials are needed to determine the efficiency, cost effectiveness, recurrence, and survival rate in robotic APR.