Comparative outcomes of laparoscopic and robotic colorectal cancer surgery in the NHS: real-world evidence from sequential adoption of Versius and da Vinci Xi

Abstract

Multiple robotic systems are now available for colorectal cancer surgery, yet comparative real-world evidence to guide NHS adoption remains limited. This study compared perioperative, oncological, and learning-curve outcomes for laparoscopic, Versius (CMR), and da Vinci Xi (dV) resections. A single-centre evaluation included elective colorectal cancer resections between November 2021 and May 2025 using laparoscopy, CMR or dV. Primary outcomes were length of stay (LOS) and operative time; secondary outcomes included lymph-node yield and Clavien–Dindo ≥ 2 complications. Analyses used non-parametric tests, Bonferroni-adjusted comparisons and multivariable regression. Learning curves were assessed with rolling means, LOWESS and CUSUM. A total of 290 patients were included: laparoscopy (n = 85), CMR (n = 103), and dV (n = 102). Median LOS was 5, 5 and 4 days respectively (p < 0.001) with dV significantly shorter than laparoscopy after adjustment (− 2.33 days; 95% CI − 3.78 to − 0.88). Risk-adjusted analysis of prolonged LOS (> 5 days) showed lower odds with dV versus CMR (OR 0.45, 95% CI 0.23–0.85; p = 0.002), with adjusted probabilities of 22.1% for dV, 37.5% for CMR and 49.0% for laparoscopy. CMR had longer adjusted operative times than laparoscopy (+ 37.2 min; p = 0.001). Lymph-node yield was highest with dV (median 25.5 vs. 22; p = 0.007), confirmed in adjusted analysis (+ 4.0 nodes; p = 0.004). Major complications were similar; CMR rectal cases had higher unadjusted rates. Learning curves showed operative time reduction for both robotic systems, with earlier plateauing for dV. Both robotic platforms were safe and oncologically equivalent; however, dV demonstrated shorter LOS, higher lymph node yield, and a more favourable learning curve.