Systemic inflammatory response after robotic versus laparoscopic abdominal surgery: a systematic review and meta-analysis with colorectal cancer subgroup analysis

Robotic surgery offers enhanced precision that can reduce tissue trauma and the systemic inflammatory response compared with laparoscopy. Clinically, a lower inflammatory response is associated with reduced postoperative pain, fewer complications, shorter hospital stay and improved oncological outcomes. This systematic review and meta-analysis compared postoperative trends in biochemical markers of the systemic inflammatory response in laparoscopic versus robotic colorectal surgery. This review was prospectively registered on PROSPERO (CRD420251167614) and reported in accordance with PRISMA guidelines. MEDLINE (PubMed), EMBASE (OvidSP), and Cochrane CENTRAL were searched for primary studies reporting biochemical surrogates of the systemic inflammatory response in adult patients following elective abdominal surgery. Eligible studies were then compared and meta-analysis performed using RevMan(Cochrane, Version 7.2.0). Eight studies (two randomised controlled trials and six observational cohort studies with an overall moderate risk of bias) involving 1,706 patients (n = 714 robotic, n = 992 laparoscopic) met inclusion criteria. C-reactive protein (CRP), albumin, and white cell count (WCC) were the most frequently reported markers of inflammation reported. Postoperative day 3 CRP was significantly lower after robotic surgery compared with laparoscopy MD - 13.18 mg/l (95% CI - 22.29, - 4.08), p = 0.005), this was further demonstrated in colorectal cancer surgery subgroup analysis [MD -17.22 (95%CI -26.28, -8.17), p = 0.0002 I²= 0%. Among secondary outcome measures, robotic surgery was associated with a significantly lower complication rate (p = 0.02) and a non-significant trend toward reduced intraoperative blood loss (p = 0.15), despite longer operative duration (mean difference 24 min). There was a non-significant trend towards shorter length of hospital stay with robotic surgery (p = 0.16). This meta-analysis demonstrated that post-operative CRP, a biochemical marker of peri-operative inflammation, was significantly lower in robotic surgery compared with laparoscopy. These findings support the hypothesis that robotic surgery potentially minimises tissue trauma and may contribute to reduced peri-operative inflammation.What does this add to the literature?While emerging evidence suggests that robotic colorectal surgery may elicit a less pronounced postoperative inflammatory response than conventional laparoscopic surgery, prior to this study there lacked a meta-analysis combining all available post robotic colorectal surgery post-operative inflammatory response data. The enhanced dexterity, tremor filtration, and improved three-dimensional visualisation offered by the robotic platform may facilitate more precise tissue handling and minimise collateral tissue trauma, however the precise biological mechanism behind this is not yet fully understood. Consequently, robotic surgery has been associated with lower postoperative inflammatory markers and a reduced physiological stress response in some studies. The implications of a lower systemic inflammatory response post robotic surgery could potentially influence choice of approach for specifically colorectal cancer patients, where a lower systemic inflammatory response, independent of complete resection (R0) and complication rates is associated with better oncological outcomes and survival.