Comparative outcomes of robotic and laparoscopic right colectomy with intracorporeal anastomosis for curative-intent right-sided colonic neoplasia: a GRADE-assessed systematic review and meta-analysis

Robotic right colectomy may facilitate complex intracorporeal dissection and reconstruction; however, previous comparative syntheses often combined laparoscopic extracorporeal anastomosis with robotic intracorporeal anastomosis. This imbalance makes it difficult to determine whether reported differences reflect the surgical platform or the reconstructive technique. We therefore compared robotic and laparoscopic right colectomy only in studies in which intracorporeal anastomosis was planned in both groups. PubMed/MEDLINE, Scopus, and Web of Science were searched from the inception to April 12, 2026. Records were deduplicated and screened in Covidence. Four non-randomized observational comparative studies were included. The primary outcome was study-defined overall postoperative morbidity, with definitions and ascertainment windows varying among studies. Secondary outcomes included operative time, conversion to open surgery, anastomotic leak, hospital stay, lymph-node harvest, and mortality. Mortality and long-term oncological outcomes were summarized narratively when comparable effect estimates were unavailable. Random-effects models, ROBINS-I, and GRADE were used for quantitative outcomes. Four studies involving 977 patients (603 robotic and 374 laparoscopic) were included. Overall postoperative morbidity occurred in 142/603 robotic and 107/374 laparoscopic patients (RR 0.84, 95% CI 0.67–1.05). No statistically significant differences were identified for conversion to open surgery (7/603 vs. 8/374; RR 0.91, 95% CI 0.13–6.33), anastomotic leak (16/603 vs. 11/374; RR 0.88, 95% CI 0.41–1.89), hospital stay (MD − 0.47 days, 95% CI − 1.00 to 0.06), or lymph node harvest (MD − 0.55 nodes, 95% CI − 3.16 to 2.06). Operative time was non-significantly longer with robotics in the primary analysis (MD 39.69 min, 95% CI − 2.19 to 81.57; I²=96%); the exploratory leave-one-out result remained heterogeneous and study-dependent. This exploratory synthesis of four non-randomized studies found no statistically significant short-term advantage of robotic over laparoscopic right colectomy when intracorporeal anastomosis was planned in both groups. These findings do not establish equivalence or exclude clinically important benefits or harms. Platform selection should therefore remain individualized according to surgeon experience, institutional workflow, resource availability, and patient and procedural complexity.