Long-term oncological outcomes of robotic versus laparoscopic approaches for right colon cancer: a systematic review and meta-analysis

Purpose: The short-term outcomes of robotic right hemicolectomy for right colon cancer have been extensively studied in comparison to conventional laparoscopic right hemicolectomy. However, the long-term oncological outcomes of the two approaches have not been investigated, except in single-center retrospective studies. Therefore, this meta-analysis aimed to investigate the long-term oncological outcomes of robotic right hemicolectomy compared with those of laparoscopic right hemicolectomy for right colon cancer. Methods: We searched PubMed, EMBASE, and Cochrane Library for studies comparing robotic right hemicolectomy with conventional laparoscopic right hemicolectomy for right colon cancer from the date of database inception to August 2022. For survival data extraction, hazard ratios (HRs) with 95% confidence intervals (CI) were calculated using random- or fixed-effects models from the Kaplan–Meier survival curves in the included studies. All calculations and statistical tests were performed using Review Manager software, version 5.4. Results: A total of 523 patients (robotic right hemicolectomy, 230; laparoscopic right hemicolectomy, 293) from five studies were included in this meta-analysis. There were no significant differences in patient characteristics between the two groups. In terms of pathological characteristics, TNM stage was not different and revealed no differences in the number of harvested lymph nodes even though a larger number of lymph nodes were harvested in the robotic group in one study. Pooled analyses demonstrated no significant difference in disease-free survival (HR 0.72, 95% CI 0.46–1.13, p = 0.15) and overall survival (HR 0.73, 95% CI 0.48–1.13, p = 0.16) between robotic and laparoscopic right hemicolectomy for right colon cancer. Conclusion: Robotic right hemicolectomy for right colon cancer is comparable with conventional laparoscopic right hemicolectomy in terms of long-term oncological survival. More prospective, multicenter, randomized trials are necessary to determine the oncologic safety of robotic right hemicolectomy.