Background. Previous studies have shown that the robotic approach has better perioperative outcomes but longer operative time than the laparoscopic approach for patients undergoing low anterior resection. However, the impact of the learning curve on operative time is controversial. This study aimed to evaluate operative time and associated outcomes by comparing robotic low anterior resection (R-LAR) with laparoscopic low anterior resection (L-LAR). Methods. Pubmed, Embase, Cochrane Library, Ovid, Web of Science, and CNKI databases were interrogated from the inception to April 2021. Two authors screened all records through full-text reading and extracted and synthesized the data using a structured table. A random-effect model was used to evaluate heterogeneity. Meta-analysis was implemented by R 4.1.1 meta-package. Results. Twelve studies (1684 patients) were included in the present review. R-LAR compare to L-LAR approach has significant differences in operative time (min) (MD = 23.14, 95% CI: 6.89-39.40, P < .01), blood loss (mL) (MD = -42.66, 95% CI: [-68.51, -16.81], P < .01), number of lymph nodes harvested (MD = 1.06, 95% CI: [.16; 1.97], P < .05). Sensitivity analysis of the number of lymph nodes harvested indicated that the overall effect might not be stable. Subgroup analysis showed that mean age and sample size of R-LAR were 2 important factors affecting the estimation. Conclusions. Our results presented a prolonged operative time with the robotic approach compared to laparoscopy, but this gap diminished as the sample size increased. It might be more timesaving once surgeons are familiar with surgical robots.
Keywords: L-LAR; R-LAR; learning curve; operative time; rectal cancer.