Abstract
Background: Colorectal cancer (CRC) is a leading global health burden (≈1.9 million new cases and 930,000 deaths in 2020). Minimally invasive surgery is standard for CRC, but the added value of robotic-assisted surgery (RAS) over conventional laparoscopy (LS) remains debated. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) from 2015-2025 comparing RAS versus LS for colorectal cancer resections. Outcomes included perioperative metrics (operative time, blood loss, conversion, complications, length of stay) and oncologic/pathologic endpoints (resection margins, lymph nodes, long-term oncologic outcomes). Methods: We searched PubMed, Embase, and Cochrane databases (2015-2025) for RCTs of RAS vs LS in CRC surgery. Study selection followed PRISMA guidelines. Data extraction and quality assessment were done independently. Meta-analyses used random-effects models to pool outcomes; forest plots were generated for key metrics. Results: Eleven RCTs (n≈3,107 total; mostly mid/low rectal cancer) met inclusion. RAS was associated with significantly longer operative time (mean difference ≈+23 min) but shorter hospital stay (median ~7 vs 8 days) and reduced blood loss in several trials. Importantly, conversion-to-open was consistently lower with RAS (e.g. 1.7% vs 3.9% in Feng 2022, p=0.021; pooled OR≈0.42 favoring RAS). Postoperative complication rates were similar or modestly lower with RAS (16.2% vs 23.1%, p=0.003 in Feng et al. 2022), and no differences were seen in serious morbidity or mortality. Pathologic quality measures (complete total mesorectal excision, number of lymph nodes) were comparable: e.g. Kim et al. (2018) reported 80.3% vs 78.1% complete TME (p=0.599). RAS showed a statistically lower positive circumferential margin rate in the largest trial (4.0% vs 7.2%, p=0.023) and pooled analyses (OR≈0.59). Long-term oncologic outcomes (disease-free or overall survival) were not mature in RCTs (e.g. Feng et al. 2022 is assessing 3-year recurrence). Conclusions: In recent RCTs, robotic colorectal surgery was safe and oncologically equivalent to laparoscopy, with advantages of fewer conversions and a lower rate of positive margins in some trials. The principal trade-off was longer operative time. Overall morbidity and short-term recovery were similar or slightly better with robotics. These findings support RAS as a viable alternative to laparoscopy in CRC resections. However, high costs and the need for surgical training must be weighed. Crucially, definitive evidence on long-term oncologic outcomes awaits further follow-up.