Background: Evidence of superiority of robotic-assisted surgery for colorectal resections remains limited. This systematic review and meta-analysis aims to compare robotic-assisted and laparoscopic surgical techniques in high-risk patients undergoing resections for colorectal cancer.

Methods: Systematic searches were performed using Pubmed, Embase and Cochrane library databases from inception until December 2024. Randomised and non-randomised studies reporting outcomes of robotic-assisted or laparoscopic resections in the following high-risk categories were included: obesity, male gender, the elderly, low rectal cancer, neoadjuvant chemoradiotherapy and previous abdominal surgery. Comparative meta-analyses for all sufficiently reported outcomes were completed. Risk of bias was assessed using the ROBINS-I and RoB 2 tools for non-randomised and randomised studies, respectively.

Results: 48 studies, including a total of 34,846 patients were eligible for inclusion and 32 studies were utilised in the comparative meta-analyses. Conversion to open rates were significantly lower for robotic-assisted surgery in patients with obesity, male patients and patients with low rectal tumours (obese OR 0.41 [CI 0.32-0.51], p < 0.00001); male gender (OR 0.28 [CI 0.22-0.34], p < 0.00001); low tumours OR 0.10 [CI 0.02-0.58], p = 0.01). Length of stay was significantly reduced for robotic-assisted surgery in patients with obesity (SMD 0.25 [CI - 0.41 to - 0.09], p = 0.002). Operative time was significantly longer in all subgroups (obesity SMD 0.57 [CI 0.31-0.83], p < 0.0001; male gender SMD 0.77 [CI 0.17-1.37], p = 0.01; elderly SMD 0.50 [CI 0.18-0.83], p = 0.002; low rectal tumours SMD 0.48 [CI 0.12-0.84], p = 0.008; neoadjuvant chemoradiotherapy SMD 0.72 [CI 0.34-1.09], p = 0.0002; previous surgery SMD 1.55 [CI 0.05-3.06], p = 0.04). When calculable, blood loss, length of stay, complication rate and lymph node yield were comparable in all subgroups.

Conclusions: This review provides further evidence of non-inferiority of robotic-assisted surgery for colorectal cancer and demonstrates conversion rates are superior in specific, technically challenging operations.

Keywords: Conversion to open; Male gender; Obesity; Operative time; Robotic-assisted surgery.

© 2025. The Author(s).

背景: 机器人辅助手术在结直肠切除术中的优越性证据仍然有限。本系统回顾和元分析旨在比较高危患者进行结直肠癌切除术时的机器人辅助与腹腔镜手术技术。

方法: 使用Pubmed、Embase和Cochrane图书馆数据库从建库开始至2024年12月进行了系统搜索。包括了报告肥胖患者、男性患者、老年患者、低位直肠癌、新辅助放化疗以及既往腹部手术患者的机器人辅助或腹腔镜切除术结果的随机和非随机研究。对于所有充分报道的结果完成了比较元分析。使用ROBINS-I工具评估非随机研究，使用RoB 2工具评估随机研究的偏倚风险。

结果: 共纳入了48项研究，总计34,846名患者，并有32项研究被用于比较元分析。在肥胖、男性和低位直肠肿瘤患者的手术中，机器人辅助手术的转开放率显著降低（肥胖OR值为0.41 [CI 0.32-0.51]，p

结论: 本综述为机器人辅助手术在治疗结直肠癌中的非劣效性提供了进一步的证据，并且表明在特定技术难度较高的操作中转开放率更优。

关键词: 转开放式；男性性别；肥胖；手术时间；机器人辅助手术。