Comparative Efficacy of Robotic-Assisted Versus Laparoscopic Resection for Colorectal Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Minimally invasive surgery is the standard of care for colorectal cancer resection. Robotic-assisted surgery (RAS) offers technical advantages over conventional laparoscopic surgery (LACS), including superior visualization and dexterity, but its clinical superiority is debatable due to higher costs and longer operative times. Previous meta-analyses were limited by the inclusion of non-randomized studies. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to provide a definitive comparison of the perioperative, functional, and oncological outcomes. A systematic search was conducted from January 2000 to December 2025. Only RCTs comparing RAS and LACS for curative-intent colorectal cancer resection were included. The primary outcomes were conversion to open surgery, operative time, and estimated blood loss. The secondary outcomes included length of hospital stay, complications (specifically Clavien-Dindo grade ≥III), and pathological metrics. The risk of bias (RoB) was assessed using the Cochrane RoB 2 tool. A meta-analysis was performed using a random-effects model. Fifteen RCTs representing thirteen unique RCTs involving 2,965 (1,487 RAS and 1,478 LACS) patients were included. RAS was associated with a significantly lower rate of conversion to open surgery (risk ratio (RR): 0.52; 95% CI: 0.35 to 0.78; p=0.001) and reduced hospital length of stay (weighted mean difference (WMD): -0.73 days; 95% CI: -1.28 to -0.19; p=0.009). Operative time was significantly longer in the RAS group (WMD: +39.26 min; p<0.001). RAS resulted in a lower rate of circumferential resection margin (CRM) positivity (RR: 0.61; 95% CI: 0.44 to 0.86; p=0.005), while lymph node harvest and overall complication rates were comparable between the groups. RAS demonstrates clear clinical benefits over conventional laparoscopy for colorectal cancer resection, specifically in reducing conversion rates, shortening hospital stay, and improving CRM status, which support the continued adoption of RAS, particularly for complex rectal cancer cases, despite the longer operative times. Future research should focus on long-term functional outcomes and their cost-effectiveness.