What about the robotic approach in rectal cancer?

Minimally invasive surgery (MIS) has improved the clinical scenario of rectal cancer, providing a solid alternative to open surgery. As MIS techniques, laparoscopic and robotic-assisted approaches have gained a clear widespread adoption in worldwide surgeons. This narrative review aims to summarize all data published to date concerning to oncological outcomes, surgical safety, and economic considerations of both approaches. Regarding oncological outcomes, both laparoscopic and robotic-assisted surgery achieve comparable results regarding mesorectal excision quality, resection margins, and lymph node retrieval. Moreover, both approaches exhibit similar postoperative complication rates, including anastomotic leakage and surgical site infections. However, some studies suggest a potential advantage for robotic surgery in specific parameters. Compared to open surgery, MIS techniques have demonstrated equivalent oncological efficacy while reducing perioperative morbidity and other outcomes are improved. Quality of life studies have been gaining interest in recent years. In this regard, MIS has improved outcomes compared to open surgery. However, the evidence needs to be increased and the heterogeneity of the studies needs to be avoided to truly assess the impact of robotic surgery. Concerning to learning curve, multiple studies have been published in recent years, based on the CUSUM methodology, to argue that learning curve is safe and can be performed with no impact on short- and long-term outcomes. Despite its potential benefits, robotic-assisted surgery is associated with higher costs and longer operative times. However, with increasing surgeon experience, new robotic devices on the market and technological advancements, these limitations probably will be surpassed. Future research should focus on long-term oncological or quality of life outcomes, assessing the cost-effectiveness of this approach.