Robotic versus laparoscopic right colectomy with complete mesocolon excision for right-sided colon cancer: a systematic review and meta-analysis

Abstract

BACKGROUND: Right colectomy with complete mesocolic excision (CME) is considered the standard for right-sided colon cancer. While laparoscopic CME (LCME) is widely performed, robotic CME (RCME) has emerged as an alternative approach. This systematic review and meta-analysis compared the perioperative, pathological, and oncological outcomes of RCME and LCME. METHODS: Following PRISMA 2020 guidelines, randomized and controlled clinical trials comparing RCME and LCME were analyzed. Primary outcomes included operative morbidity, blood loss, bleeding, conversion to open surgery, and operative time. Odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CIs) were calculated using a random-effects model. Certainty of evidence was assessed using GRADE. RESULTS: Seven studies comprising 733 patients (364 RCME and 369 LCME) were included. Postoperative morbidity did not differ significantly between RCME and LCME (OR 0.95, 95% CI 0.66-1.37; p = 0.79). Blood loss was comparable between groups (MD - 4.6 mL, 95% CI - 27.7 to 18.5; p = 0.70). RCME showed a lower conversion rate to open surgery (OR 0.07, 95% CI 0.01-0.52; p = 0.01), though this was based on a few events and low-certainty evidence. Operative time was longer with RCME (MD 45.6 min, 95% CI 27.5-63.8; p < 0.00001). There were no significant differences in postoperative ileus (OR 0.88, 95% CI 0.40-1.92; p = 0.74), hospital stay (MD - 0.10 days, 95% CI - 0.61 to 0.40; p = 0.69), or lymph node yield (MD 2.05, 95% CI - 1.53-5.63; p = 0.26). Oncological outcomes were similar between RCME and LCME for disease-free survival (OR 1.25, 95% CI 0.48-3.30; p = 0.65) and overall survival (OR 1.00, 95% CI 0.14-7.20; p = 1.00). The certainty of evidence ranged from low to moderate for most endpoints. CONCLUSIONS: RCME and LCME demonstrate comparable surgical, pathological, and oncological outcomes. RCME may be associated with a lower conversion rate, though this finding is uncertain due to the limited number of events and inter-study heterogeneity. Further high-quality randomized trials are warranted to confirm these observations and clarify cost-effectiveness.