Robotic-Assisted versus Laparoscopic Surgery for Colorectal Resection in Oncologic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background Colorectal cancer (CRC) is a leading global health burden (≈ 1.9 million new cases and 930,000 deaths in 2020) [1]. Minimally invasive surgery is standard for CRC, but the added value of robotic-assisted surgery (RAS) over conventional laparoscopy (LS) remains debated. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) from 2015–2025 comparing RAS versus LS for colorectal cancer resections. Outcomes included perioperative metrics (operative time, blood loss, conversion, complications, length of stay) and oncologic/pathologic endpoints (resection margins, lymph nodes, long-term oncologic outcomes). Methods We searched PubMed, Embase, and Cochrane databases (2015–2025) for RCTs of RAS vs LS in CRC surgery following PRISMA guidelines. Meta-analyses used random-effects models to pool outcomes. Results Eleven RCTs (n ≈ 3,107 total) met inclusion. RAS was associated with significantly longer operative time (mean difference ≈ + 23 min) but shorter hospital stay (median ~ 7 vs 8 days) and reduced blood loss in several trials. Importantly, conversion-to-open was consistently lower with RAS (e.g., 1.7% vs 3.9% [2]). Postoperative complication rates were similar or modestly lower with RAS (16.2% vs 23.1% [2]), and no differences were seen in serious morbidity or mortality. Pathologic quality measures (complete total mesorectal excision, number of lymph nodes) were comparable [3]. RAS showed a statistically lower positive circumferential margin rate (4.0% vs 7.2% [2]). Long-term oncologic outcomes were not yet mature [2]. Conclusions Robotic colorectal surgery was safe and oncologically equivalent to laparoscopy, with advantages of fewer conversions and lower positive margin rates in some trials [2][3][4]. The principal trade-off was longer operative time. RAS is a viable alternative to laparoscopy in CRC resections, pending further data on long-term outcomes.