Laparoscopic versus robotic surgery for colorectal cancer: an updated meta-analysis with comparison against published...

The comparative effectiveness of robotic versus laparoscopic surgery for colorectal cancer remains debated. We performed an updated meta-analysis through June 2026, with cross-validation against published systematic reviews. PubMed was searched for comparative studies of laparoscopic versus robotic colorectal surgery. After deduplication, 51 primary studies met inclusion criteria; three verified published meta-analyses (2023-2025) were cross-referenced. Meta-analysis used Mantel-Haenszel odds ratios (OR) with DerSimonian-Laird random-effects models, computed as robotic/laparoscopic (OR > 1 indicates higher event rates with robotic surgery). Only studies providing extractable abstract-level event counts contributed to quantitative synthesis. Primary outcomes were overall complications, anastomotic leak, and conversion to open surgery. Of 51 eligible studies, extractable abstract-level data supported quantitative analysis for complications (4 studies, 654 patients), anastomotic leak (3 studies, 840 patients), and conversion (5 studies, 2,331 patients). In these limited abstract-level data, robotic surgery was associated with higher rates across all three primary outcomes: complications (RE OR 1.54, 95% CI 0.59-4.06, I² = 68.5%), anastomotic leak (RE OR 2.74, 95% CI 1.71-4.40, I² = 0%), and conversion to open surgery (RE OR 4.00, 95% CI 2.18-7.32, I² = 54.3%). These findings conflict with several published systematic reviews that report robotic advantages for conversion and mixed results for anastomotic leak. In this abstract-level meta-analysis, the limited extractable data show higher event rates with robotic surgery, likely reflecting confounding by indication (selective use of robotic platforms for more complex cases) rather than genuine platform inferiority. The quantitative results, based on only 3-5 studies per outcome (8-10% of eligible studies), are unsuitable for clinical inference. Cross-validation against published full-text systematic reviews reveals contradictory findings, emphasizing that abstract-level data extraction is methodologically inadequate for surgical meta-analysis and that standardized reporting of exact event counts in abstracts is urgently needed.