Robot-assisted versus laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of randomised trials with GRADE certainty rating- Review Article
- Published: 11 August 2026
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AbstractBackgroundRobot-assisted rectal cancer surgery is being adopted rapidly, yet prior meta-analyses have emphasised intermediate endpoints and have not rated the certainty of evidence. We compared the two approaches using a strictly randomised evidence base, with formal certainty rating and robustness testing. MethodsWe searched PubMed/MEDLINE, Embase and Cochrane CENTRAL from inception to 28 March 2026 for randomised controlled trials. Pre-specified primary outcomes were total operative time and major complications (Clavien每Dindo grade ≡ III). Outcomes were pooled using random-effects models with restricted maximum likelihood estimation and Hartung每Knapp每Sidik每Jonkman confidence intervals; risk of bias was assessed per outcome (RoB 2) and certainty rated with GRADE (PROSPERO CRD420261383724). ResultsSeven independent trials (2,540 patients) were synthesised. Robot-assisted surgery was associated with longer operative time (MD 39.8 min, 95% CI 4.4 to 75.3) and fewer conversions (OR 0.52, 0.30 to 0.91), with no difference in major complications (OR 0.69, 0.36 to 1.31). Estimates favouring robot-assisted surgery for circumferential margin positivity (OR 0.62, 0.37 to 1.05) and complete mesorectal excision (OR 1.47, 0.92 to 2.36) were not significant and attenuated when the largest trial was excluded. Disease-free and overall survival did not differ. Certainty was low or very low throughout. One trial judged robot-assisted surgery not cost-effective; none reported environmental outcomes. ConclusionsCurrent randomised evidence does not establish clear overall superiority of robot-assisted over laparoscopic rectal cancer surgery, despite fewer conversions, and indicates higher direct costs where reported. These largely confirmatory findings suggest outcomes depend more on patient and surgeon factors than on the platform. Trial registrationPROSPERO (CRD420261383724).
Explore related subjects[size=0.875]Discover the latest articles, books and news in related subjects, suggested using machine learning.Data availabilityThe full extracted dataset, the analysis code, and the certainty-of-evidence worksheets are available to editors and reviewers on request and will be made publicly available on the Open Science Framework (OSF) upon publication.
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FundingThis systematic review received no external funding. No commercial entity provided financial support.
Author informationAuthors and AffiliationsSchool of Medicine, Kangwon National University, Chuncheon, Republic of Korea Sang-ji Choi & Gibong Chae Department of Surgery, Kangwon National University Hospital, Chuncheon, Republic of Korea Sang-ji Choi & Gibong Chae
ContributionsS.C. conceived and designed the review, performed the analysis and drafted the manuscript. G.C. contributed to study selection, data extraction, risk-of-bias assessment and critical revision. Both authors approved the final version. Corresponding author
Ethics declarationsDisclosuresDrs. Sang-ji Choi and Gibong Chae have no conflicts of interest or financial ties to disclose. Ethical approvalNot required; this study is a systematic review and meta-analysis of previously published, aggregate data and involved no new human or animal participants. Use of artificial intelligenceThe authors used a generative artificial intelligence tool (a large language model; Claude Opus 4.8, Anthropic; accessed on June 2026) during preparation of this manuscript. It was used to assist with organisation of the extracted data, to help write and debug the Python scripts used for the statistical analysis and to provide language editing of author-written drafts. The tool was not used to design the study, to make eligibility or risk-of-bias judgments or to create, alter or interpret the original research data or results. All artificial intelligence-assisted output was directed, reviewed and verified by the authors, who take full responsibility for the accuracy and integrity of the content.
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Cite this articleChoi, Sj., Chae, G. Robot-assisted versus laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of randomised trials with GRADE certainty rating. Surg Endosc (2026). [url]https://doi.org/10.1007/s00464-026-13273-8
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