{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:28:04Z","timestamp":1792196884859,"version":"4.4.0"},"reference-count":49,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Laparoscopic surgery (LS) is widely recognized as the standard minimally invasive method for colorectal cancer. Although robotic surgery (RS) has seen increased adoption, its clinical and economic advantages over LS remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A systematic search was carried out across PubMed, Scopus, and the Cochrane Central Register up to March 2025. Only randomized controlled trials (RCTs) directly comparing RS and LS were included. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed via the\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistic. Trial sequential analysis (TSA) was applied to assess the robustness of the cumulative evidence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Fourteen RCTs encompassing 2867 patients were included. Compared with LS, RS significantly lowered the conversion rate to open surgery (RR = 0.54; 95% CI: 0.36\u20130.80;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002), time to first stool (MD = \u22120.33 days; 95% CI: \u22120.60 to \u22120.06;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .016), and positive circumferential resection margin (CRM) (RR = 0.65; 95% CI: 0.46\u20130.93;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .017). Sensitivity analysis revealed a slight benefit for RS in time to first flatus (MD = \u22120.13 days;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .03). RS was associated with a longer surgery duration (MD = +49.4 minutes; 95% CI: 18.0\u201380.7;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002). No significant differences were observed for intraoperative blood loss, postoperative complications, or cancer recurrence. TSA confirmed definitive findings for selected outcomes, while others remained underpowered.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>RS and LS showed equivalent results for postoperative complications and cancer-related outcomes. RS was advantageous in reducing conversion and CRM positivity, despite longer operative time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/lap.2025.0088","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T03:27:37Z","timestamp":1750130857000},"page":"621-639","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["Robotic Versus Laparoscopic Surgery for Colorectal Cancer: A Trial Sequential Meta-Analysis of Randomized Trials"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2960-3810","authenticated-orcid":false,"given":"Bernardo Fontel","family":"Pompeu","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, Heliopolis Hospital, S\u00e3o Paulo, Brazil."},{"name":"University of S\u00e3o Caetano do Sul, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds Eduardo Braz","family":"de Moraes Alves","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Heliopolis Hospital, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz D\u2019Andrea","family":"Pigossi","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Heliopolis Hospital, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Leal","family":"Barone","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Caetano do Sul, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7687-3073","authenticated-orcid":false,"given":"Lucas Monteiro","family":"Delgado","sequence":"additional","affiliation":[{"name":"Federal University of Minas Gerais, Belo Horizonte, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas Soares de Souza Pinto","family":"Guedes","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Caetano do Sul, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio Mazzola","family":"Poli de Figueiredo","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of North Carolina, Chapel Hill, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda Bellotti","family":"Formiga","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Heliopolis Hospital, S\u00e3o Paulo, Brazil."},{"name":"Department of Colorectal Surgery, Hospital of Santa Casa de Misericordia, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2022-327736"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21772"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-008-9752-z"},{"key":"e_1_3_3_5_2","first-page":"5836562","article-title":"Robotic-assisted versus conventional laparoscopic approach for rectal cancer surgery, first Egyptian academic center experience, RCT","volume":"2018","author":"Debakey Y","year":"2018","unstructured":"Debakey Y, , Zaghloul A, , Farag A, et al. 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