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Robotic Versus Laparoscopic Rectal Cancer Surgery in Obese Patients: A Frequentist and Bayesian Meta-Analysis
Mateus Lima Ulisses Trindade1, Thaís Henriques Abud1, Maria Eduarda Caetano Batista de Paiva1
1Department of Surgery, Heliopolis Hospital, São Paulo, Brazil.
Summary
Robotic rectal cancer surgery in obese patients offers shorter hospital stays but longer operative times compared to laparoscopy. Outcomes like morbidity and conversion rates were similar, though Bayesian analysis hinted at potential benefits for robotic approaches.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Bariatric Surgery
Background:
- Obesity presents significant technical challenges in rectal cancer surgery (RCS).
- Robotic surgery may offer improved operative performance in obese patients undergoing RCS.
Purpose of the Study:
- To systematically review and meta-analyze studies comparing robotic and laparoscopic approaches for rectal cancer surgery in obese patients.
Main Methods:
- Systematic search of major databases (PubMed, Web of Science, Scopus, Cochrane) up to May 2026.
- Random-effects models for pooled odds ratios and mean differences.
- Bayesian analyses for overall morbidity and conversion to open surgery.
Main Results:
- Five observational studies (531 patients) included; 280 robotic RCS, 251 laparoscopic RCS.
- Robotic surgery showed significantly shorter hospital stay (MD = -1.8 days) but longer operative time (MD = 48.5 minutes).
- No significant differences in conversion to open surgery, overall morbidity, or key pathological outcomes.
Conclusions:
- Robotic RCS in obese patients is associated with shorter hospitalization but increased operative time.
- Perioperative morbidity and pathological outcomes were comparable, with Bayesian analyses suggesting potential benefits for robotic surgery that require cautious interpretation.
- Further high-quality prospective studies are essential to validate these findings.
