Robotic versus laparoscopic surgery for rectal cancer in overweight and obese patients: pathological outcomes, complications, and trial sequential analysis.

This study compared robotic versus laparoscopic surgery for rectal cancer (RC) in overweight and obese patients, focusing on pathological outcomes and complications. A total of 1691 patients from seven eligible clinical studies were analyzed, including 769 cases undergoing robotic surgery and 922 laparoscopic procedures. Trial sequential analysis was applied to assess the reliability of significant findings and determine whether the accumulated evidence was conclusive. Comparative analysis revealed no significant differences between the two approaches for several critical pathological parameters: lymph node yield, R0 resection rate, positive circumferential resection margin rate, and distal resection margin distance. However, the robotic group had a significantly shorter proximal resection margin, a finding that did not compromise R0 resection rates. Regarding complications, the robotic group had less estimated blood loss, a lower overall complication rate, and a lower conversion rate to open surgery. No statistically significant disparities were found between the groups for specific postoperative complications, including anastomotic leakage, ureteric injury, urinary retention, and ileus. In conclusion, for overweight and obese patients with RC, robotic and laparoscopic surgery provide comparable pathological outcomes. Nevertheless, robotic surgery is associated with favorable perioperative safety advantages, including less blood loss, lower conversion rate to open surgery, and fewer overall complications.