Robotic vs. laparoscopic rectal cancer surgery in high BMI patients: a systematic review and meta-analysis.

OBJECTIVE

To compare the perioperative outcomes, postoperative complications, and oncologic results between robotic-assisted and laparoscopic rectal cancer surgeries in patients with high BMI.

METHODS

A meta-analysis was conducted under the PRISMA guidelines. PubMed, SCOPUS, Embase, and Cochrane Library databases were searched from inception to May 2025 for studies comparing robotic and laparoscopic rectal cancer surgeries among patients with BMI ≥ 28 kg/m2. Five studies included data for 700 cases in the robotic group (RG) and 2102 cases in the laparoscopic group (LG). The main areas of outcome investigations included operative time, length of hospital stay (LOHS), conversion rates, overall postoperative complications, and harvested lymph nodes. Pooled estimates were analyzed using the random-effect models.

RESULTS

The pooled analysis of five studies showed that the robotic group had a significantly shorter hospital stay and a lower conversion rate than the laparoscopic group (P < 0.05), while operative time was approximately 30 min shorter in the laparoscopic group (P < 0.05). Following exclusion of Zhao 2024, subanalysis of the remaining four studies demonstrated that the laparoscopic group still had a significantly shorter operative time and the robotic group maintained a significantly lower conversion rate; however, a significant difference in hospital stay was no longer present, and no significant differences were found for harvested lymph nodes or postoperative complications. No major difference was observed concerning lymph node yield and readmission rates between the surgical measures.

CONCLUSION

Robotic surgery was associated with a significantly lower conversion rate, whereas laparoscopic surgery was associated with significantly shorter operative times; no consistent advantage was observed for hospital stay, as this finding was not replicated in sensitivity analysis. Further high-quality studies are warranted to confirm these results.