Robotic TME associated with more sphincter-preserving rectal resections

Design

Systematic review and random-effects meta-analysis, PROSPERO-registered

Population

20 studies, 7,133 patients having TME for rectal cancer

Primary outcome

Restorative resection (primary anastomosis)

Effect

OR 1.43 (95% CI 1.04 to 1.98); conversion OR 0.37 (0.28 to 0.49)

A registered systematic review and meta-analysis pooled 20 studies of 7,133 patients comparing robot-assisted with laparoscopic total mesorectal excision for rectal cancer, searched from 2010 to January 2026.

Robotic surgery was associated with a higher likelihood of restorative resection, meaning a primary anastomosis rather than a permanent stoma (OR 1.43, 95% CI 1.04 to 1.98). In studies of patients treated after 2020, the association was stronger (OR 2.86). Conversion to open surgery was less common (OR 0.37). Anastomotic leak, overall complications, reoperation and readmission did not differ.

Most included studies were not randomised, so surgeons may have chosen robotic surgery for patients in whom they expected to preserve the sphincter. The stronger recent effect may reflect growing expertise, as the authors suggest, or changing selection.

Whether more anastomoses translate into better quality of life is not known; a low anastomosis can bring low anterior resection syndrome. For units without a robot, the comparison does not change the standard of laparoscopic or open TME.

• Counsel patients that robotic TME may increase the chance of avoiding a permanent stoma, on observational evidence.
• Discuss low anterior resection syndrome alongside sphincter preservation.
• Leak rates did not differ, so the choice of platform should not change anastomotic surveillance.
• Expect fewer conversions with robotic access, which may matter most in a narrow male pelvis.

Why it matters

Stoma avoidance is what many rectal cancer patients care about most, and this is the outcome where the robot may differ.

Don't overread it

Most included studies were observational, and more anastomoses do not necessarily mean better bowel function.

The statistics, in plain English

An odds ratio of 1.43 with an interval of 1.04 to 1.98 suggests a real but uncertain advantage; the lower end is close to no effect. The post-2020 subgroup result is larger but rests on fewer studies and is weaker evidence than the pooled estimate.

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