Does robotic intersphincteric resection better preserve anal function in low rectal cancer: a systematic review and meta-analysis?

Backgroud Intersphincteric resection (ISR) is an important and challenging sphincter-preserving procedure for patients with low rectal cancer. Preserving anal function is more important than preserving its appearance. Owing to its unique advantages, the robotic platform makes ISR safer and less invasive. Whether this advantage is reflected in functional aspects is worth further exploration. Methods PubMed, Cochrane Library and Embase were systematic researched for articles published relevant literature. The literature was screened independently by two groups, and data on functional, perioperative, and oncology outcomes were extracted and evaluated for bias. Meta-analysis was performed using Revman5.4 software. Results Ten studies with a total of 1279 patients were included in our meta-analysis, and Funnel plots suggested no major publication bias. The robotic ISR group had lower Wexner scores [MD = –1.46, 95%CI (–2.03 ∼–0.88), p < 0.001] than the laparoscopic ISR group, but with no significant difference compared to other functional outcomes. The robotic ISR group performed better in preserving the integrity of the rectal mesentery [OR = 3.08, 95%CI (1.72, 5.53), p = 0.0002], had less intraoperative bleeding [MD = –11.47, 95%CI (–17.25, –5.68), p = 0.0001], and had fewer postoperative complications [OR = 0.71, 95%CI (0.53, 0.94), p = 0.02], although the operation took longer [MD = 0.76, 95%CI (0.62∼0.91), p < 0.001]. No significant differences were observed in the long-term oncological outcomes between the two groups. Conclusion Robotic ISR has potential advantages in preserving the anal function, with fewer complications and similar oncological outcomes compared with Laparoscopic ISR. Due to limitations in sample size and study design, the results of this study still require validation through randomized controlled trials. Systematic review registration https://www.crd.york.ac.uk/PROSPERO , identifier CRD420251012991.