Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial

AIM: To compare outcomes in patients undergoing rectal resection by robotic total meso-rectal excision (RTME) vs laparoscopic total meso-rectal excision (LTME). METHODS: Standard medical electronic databases such as PubMed, MEDLINE, EMBASE and Scopus were searched to find relevant articles. The data retrieved from all types of included published comparative trials in patients undergoing RTME vs LTME was analysed using the principles of meta-analysis. The operative, post-operative and oncological outcomes were evaluated to assess the effectiveness of both techniques of TME. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR). RESULTS: One RCT (ROLARR trial) and 27 other comparative studies reporting the non-oncological and oncological outcomes following RTME vs LTME were included in this review. In the random effects model analysis using the statistical software Review Manager 5.3, the RTME was associated with longer operation time (SMD, 0.46; 95%CI: 0.25, 0.67; z = 4.33; P = 0.0001), early passage of first flatus (P = 0.002), lower risk of conversion (P = 0.00001) and shorter hospitalization (P = 0.01). The statistical equivalence was seen between RTME and LTME for non-oncological variables like blood loss, morbidity, mortality and re-operation risk. The oncological variables such as recurrence (P = 0.96), number of harvested nodes (P = 0.49) and positive circumferential resection margin risk (P = 0.53) were also comparable in both groups. The length of distal resection margins was similar in both groups. CONCLUSION: RTME is feasible and oncologically safe but failed to demonstrate any superiority over LTME for many surgical outcomes except early passage of flatus, lower risk of conversion and shorter hospitalization.