Abstract Relevance and aims Rectal cancer is one of the world’s most common malignancies, with 700 000 new diagnoses per year globally. Robotic assisted surgery (RAS) is increasingly common in the UK and has several technical advantages. While there have been many previous studies comparing laparoscopy to RAS, few reviews have focussed on recent practice within the last five years. As experience amongst surgeons performing RAS increases it is unclear if outcomes are changing. Methods A systematic review of the literature within the last five years was conducted using the databases PubMed (including Medline and the Cochrane library) and Scopus, to compare eight different outcomes: intra-operative blood loss, number of harvested lymph nodes, operative time, rate of conversion to open surgery, duration of hospital stay, urinary retention rate, anastomotic leakage rate, and survival. Results 24 studies were included, consisting of 7899 patients. The RAS group had statistically significant lower postoperative days in hospital and lower conversion rates to open surgery, albeit with significantly higher operating time. There were no significant differences between the groups for the other outcomes. Conclusions RAS is useful for low rectal cancer and the less accessible pelvis; it may also have a greater ability to preserve pelvic nerves and their function. The shorter hospital stay may have a health economic benefit but must be weighed against longer operating time and associated theatre costs. Future research should focus on comparisons between experienced laparoscopic surgeons and experienced robotic surgeons to best compare outcomes.
Smith et al. (2026) studied this question.