Robotic TME linked to more restorative rectal resections

Design

Systematic review and meta-analysis of 20 comparative studies

Population

7,133 patients undergoing robotic or laparoscopic TME for rectal cancer

Primary outcome

Restorative resection with primary anastomosis

Effect

OR 1.43 (1.04-1.98); conversion OR 0.37 (0.28-0.49)

This systematic review and meta-analysis pooled 20 studies, mostly non-randomised, with 7,133 patients undergoing robotic or laparoscopic total mesorectal excision for rectal cancer between 2010 and 2026.

Robotic TME was associated with a higher chance of a restorative resection with primary anastomosis (OR 1.43, 95% CI 1.04 to 1.98). In studies of patients treated after 2020 the association was stronger (OR 2.86, 1.80 to 4.53), which the authors attribute to growing robotic experience. Conversion to open surgery was less frequent (OR 0.37, 0.28 to 0.49). Anastomotic leak, complications, reoperation and readmission did not differ.

For a surgeon deciding between approaches in a narrow male pelvis or a low tumour, this supports the robot as a route to avoiding a permanent stoma, without an apparent penalty in leaks. But choosing to anastomose is a surgeon's decision, and in non-randomised series it reflects case selection as much as technique. Whether the extra anastomoses translate into better bowel function and quality of life is not yet known; low anterior resection syndrome can make a restored bowel a mixed blessing.

• Consider robotic TME where available for low or technically difficult rectal tumours where a stoma is otherwise likely.
• Counsel patients that restorative surgery may bring low anterior resection syndrome.
• Record conversion and stoma decisions prospectively to audit your own unit's results.
• Do not expect fewer anastomotic leaks from the robot; the rate was similar.

Why it matters

The case for the robot in rectal surgery shifts from operative comfort to the patient's chance of avoiding a stoma.

Don't overread it

Most included studies were non-randomised, so selection may explain part of the difference.

The statistics, in plain English

An odds ratio of 1.43 with an interval from 1.04 to 1.98 is a modest but real association. The post-2020 subgroup (OR 2.86) is larger, but subgroup results are weaker evidence than the overall estimate and may reflect different patient selection in newer series.

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