Robotic versus laparoscopic resection for transverse colon and splenic flexure cancer: a systematic review and...

Transverse colon and splenic flexure cancer resections are technically demanding because of variable vascular anatomy, multiquadrant dissection, and proximity to the pancreas and spleen. This systematic review and meta-analysis compared robotic and laparoscopic outcomes and separately summarized published robotic experience. MEDLINE/PubMed, Embase/Ovid, Scopus, and the Cochrane Database of Systematic Reviews were searched through 18 July 2026. Six non-randomized comparative studies included 167 robotic and 296 laparoscopic patients. Overall morbidity (risk ratio [RR] 1.02, 95% confidence interval [CI] 0.72-1.45), major morbidity (RR 0.61, 95% CI 0.27-1.34), anastomotic leakage (RR 0.62, 95% CI 0.22-1.79), reoperation, and lymph-node yield did not differ significantly. Conversion occurred in 0 of 149 robotic and 14 of 278 laparoscopic procedures (Peto odds ratio 0.19, 95% CI 0.06-0.62), although events were sparse. Robotic surgery was associated with a shorter hospital stay (mean difference - 1.01 days, 95% CI -1.66 to -0.37), whereas operative time was highly heterogeneous. Across 10 robotic cohorts comprising 201 patients, pooled overall morbidity was 22.4%, major morbidity 4.9%, anastomotic leakage 3.0%, and R0 resection 98.4%; no 30-day death occurred among 183 reporting patients. Robotic resection is feasible and provides short-term and pathological outcomes comparable with laparoscopy. The shorter hospital stay and lower observed conversion rate suggest clinical advantages, supporting robotic surgery as a valuable minimally invasive option in experienced centers while awaiting confirmation from standardized prospective studies.