Robotic rectal resection preserves anorectal function: Systematic review and meta-analysis

Background: Improving survival rates in rectal cancer patients has generated a growing interest in functional outcomes after total mesorectal excision (TME). The well-established low anterior resection syndrome (LARS) score assesses postoperative anorectal impairment after TME. Our meta-analysis is the first to compare bowel function after open, laparoscopic, transanal, and robotic TME. Methods: All studies reporting functional outcomes after rectal cancer surgery (LARS score) were included, and were compared with a consecutive series of robotic TME (n = 48). Results: Thirty-two publications were identified, including 5 565 patients. Anorectal function recovered significantly better within one year after robotic TME (3.8 [95%CI –9.709–17.309]) versus laparoscopic TME (26.4 [95%CI 19.524–33.286]), p = 0.006), open TME (26.0 [95%CI 24.338–29.702], p = 0.002) and transanal TME (27.9 [95%CI 22.127–33.669], p = 0.003). Conclusions: Robotic TME enables better recovery of anorectal function compared to other techniques. Further prospective, high-quality studies are needed to confirm the benefits of robotic surgery.