title: Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis.
abstract: BACKGROUND
  Robotic surgery has been used successfully in many branches of surgery; but there is little evidence in the literature on its use in rectal cancer (RC). We conducted this meta-analysis that included randomized controlled trials and nonrandomized controlled trials of robotic total mesorectal excision (RTME) versus laparoscopic total mesorectal excision (LTME) to evaluate whether the safety and efficacy of RTME in patients with RC are equivalent to those of LTME.
  
  
  METHODS
  Pubmed, Embase, Cochrane Library, Ovid, and Web of Science databases were searched. Studies clearly documenting a comparison of RTME with LTME for RC were selected. Operative and recovery outcomes, early postoperative morbidity, and oncological parameters were evaluated.
  
  
  RESULTS
  Eight studies were identified that included 1229 patients in total, 554 (45.08%) in the RTME and 675 (54.92%) in the LTME. Meta-analysis suggested that the conversion rate to open surgery in RTME was significantly lower than in LTME (P = 0.0004). There were no significant differences in operation time, estimated blood loss, recovery outcome, postoperative morbidity and mortality, length of hospital stay, and the oncological accuracy of resection and local recurrence between the two groups. The positive rate of circumferential resection margins (P = 0.04) and the incidence of erectile dysfunction (P = 0.002) were lower in RTME compared with LTME.
  
  
  CONCLUSIONS
  RTME for RC is safe and feasible, and the short- and medium-term oncological and functional outcomes are equivalent or preferable to LTME. It may be an alternative treatment for RC. More multicenter randomized controlled trials investigating the long-term oncological and functional outcomes are required to determine the advantages of RTME over LTME in RC.
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China. Electronic address: xbh791220@163.com.
authors.forename: Binghong
authors.initials: B
authors.lastname: Xiong
authors.affiliation: Department of Internal Medicine, Chongqing Huaxi Hospital, Chongqing, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
authors.forename: CaiQuan
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China. Electronic address: 351893768@qq.com.
authors.forename: Yong
authors.initials: Y
authors.lastname: Cheng
mesh_terms: D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D012371:Robotics
keywords: Laparoscopy; Meta-analysis; Rectal cancer; Robotic; Total mesorectal excision