{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T09:23:06Z","timestamp":1787304186580,"version":"build-2736575974"},"reference-count":47,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Science","doi-asserted-by":"publisher","award":["UL1 TR001863"],"award-info":[{"award-number":["UL1 TR001863"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"award":["UL1 TR001863"],"award-info":[{"award-number":["UL1 TR001863"]}],"id":[{"id":"https:\/\/ror.org\/04pw6fb54","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and Health Services Research and Development"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The surgical management of rectal cancer has evolved from open resection to laparoscopic and, more recently, robotic minimally invasive approaches. Laparoscopy established the short-term benefits of minimally invasive rectal surgery but is limited within the confines of the bony pelvis, prompting adoption of the robotic platform with its three-dimensional visualization, wristed instruments, and tremor filtration. Whether these refinements translate into measurable clinical benefit remains debated. This narrative review compares the two approaches across oncologic, perioperative, functional, and economic domains. Pathologic outcomes are broadly equivalent, though contemporary evidence\u2014most notably the REAL trial\u2014suggests a possible emerging robotic advantage, although further study is necessary in this regard. Robotic surgery offers potential advantages in conversion rates, blood loss, and postoperative urinary and sexual function, while laparoscopy retains advantages in operative time and cost. At present, platform choice should be guided by patient anatomy, tumor characteristics, and surgical expertise, with robotic surgery likely most valuable in anatomically challenging cases where laparoscopy is most limited.<\/jats:p>","DOI":"10.3390\/cancers18162707","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:14:01Z","timestamp":1787300041000},"page":"2707","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing the Oncologic and Surgical Outcomes of Laparoscopic Versus Robotic Rectal Cancer Surgery: A Narrative Review"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3325-3664","authenticated-orcid":false,"given":"Alexander","family":"Rossi","sequence":"first","affiliation":[{"name":"Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7955-824X","authenticated-orcid":false,"given":"Yuqing","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6572-8658","authenticated-orcid":false,"given":"Ira L.","family":"Leeds","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"},{"name":"Surgery Service, United States Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/S1470-2045(13)70016-0","article-title":"Laparoscopic versus open surgery for rectal cancer (COLOR II): Short-term outcomes of a randomised, phase 3 trial","volume":"14","author":"Haglind","year":"2013","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/S1470-2045(10)70131-5","article-title":"Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): Short-term outcomes of an open-label randomised controlled trial","volume":"11","author":"Kang","year":"2010","journal-title":"Lancet Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1002\/bjs.1800691019","article-title":"The mesorectum in rectal cancer surgery--the clue to pelvic recurrence?","volume":"69","author":"Heald","year":"1982","journal-title":"Br. J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1001\/jama.2015.12009","article-title":"Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial","volume":"314","author":"Stevenson","year":"2015","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1001\/jama.2015.10529","article-title":"Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial","volume":"314","author":"Fleshman","year":"2015","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1097\/SLA.0000000000003021","article-title":"Disease-free Survival and Local Recurrence After Laparoscopic-assisted Resection or Open Resection for Rectal Cancer: The Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial","volume":"269","author":"Stevenson","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1097\/SLA.0000000000003002","article-title":"Disease-free Survival and Local Recurrence for Laparoscopic Resection Compared with Open Resection of Stage II to III Rectal Cancer: Follow-up Results of the ACOSOG Z6051 Randomized Controlled Trial","volume":"269","author":"Fleshman","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1001\/jamaoncol.2022.4079","article-title":"Short-term Outcomes of Laparoscopy-Assisted vs Open Surgery for Patients with Low Rectal Cancer: The LASRE Randomized Clinical Trial","volume":"8","author":"Jiang","year":"2022","journal-title":"JAMA Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1046\/j.0007-1323.2001.02024.x","article-title":"Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer","volume":"89","author":"Wibe","year":"2002","journal-title":"Br. J. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1245\/s10434-006-9171-0","article-title":"Prognostic significance of circumferential resection margin following total mesorectal excision and adjuvant chemoradiotherapy in patients with rectal cancer","volume":"14","author":"Baik","year":"2007","journal-title":"Ann. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1001\/jama.2017.7219","article-title":"Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial","volume":"318","author":"Jayne","year":"2017","journal-title":"JAMA"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/SLA.0000000000003227","article-title":"Open Versus Laparoscopic Versus Robotic Versus Transanal Mesorectal Excision for Rectal Cancer: A Systematic Review and Network Meta-analysis","volume":"270","author":"Simillis","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1007\/s00464-012-2731-4","article-title":"Total mesorectal excision: A comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer","volume":"27","author":"Pernazza","year":"2013","journal-title":"Surg. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/SLA.0000000000005788","article-title":"Comparison of Laparoscopic Versus Robot-Assisted Surgery for Rectal Cancers: The COLRAR Randomized Controlled Trial","volume":"278","author":"Park","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1016\/S2468-1253(22)00248-5","article-title":"Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): Short-term outcomes of a multicentre randomised controlled trial","volume":"7","author":"Feng","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1097\/SLA.0000000000002523","article-title":"Robotic Versus Laparoscopic Minimally Invasive Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials","volume":"267","author":"Prete","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s12957-021-02128-2","article-title":"Comparison of robotic and laparoscopic rectal cancer surgery: A meta-analysis of randomized controlled trials","volume":"19","author":"Tang","year":"2021","journal-title":"World J. Surg. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s00423-024-03460-3","article-title":"Outcomes of robotic versus laparoscopic-assisted surgery in patients with rectal cancer: A systematic review and meta-analysis","volume":"409","author":"Khan","year":"2024","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1007\/s00384-018-3145-0","article-title":"Robotic versus laparoscopic intersphincteric resection for low rectal cancer: A systematic review and meta-analysis","volume":"33","author":"Lee","year":"2018","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s00464-012-2405-2","article-title":"Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: A retrospective comparison with conventional laparoscopy","volume":"27","author":"Park","year":"2013","journal-title":"Surg. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1007\/s00464-008-9752-z","article-title":"Robotic tumor-specific mesorectal excision of rectal cancer: Short-term outcome of a pilot randomized trial","volume":"22","author":"Baik","year":"2008","journal-title":"Surg. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e134","DOI":"10.1111\/j.1463-1318.2011.02907.x","article-title":"Robotic resection compared with laparoscopic rectal resection for cancer: Systematic review and meta-analysis of short-term outcome","volume":"14","author":"Trastulli","year":"2012","journal-title":"Colorectal Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1002\/(SICI)1097-0142(20000401)88:7<1739::AID-CNCR30>3.0.CO;2-T","article-title":"American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group","volume":"88","author":"Compton","year":"2000","journal-title":"Cancer"},{"key":"ref_24","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","year":"2018","journal-title":"Minim. Invasive Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.1007\/s00464-016-5165-6","article-title":"Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid-low rectal cancer following neoadjuvant chemoradiation therapy","volume":"31","author":"Lim","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1001\/jama.2025.8123","article-title":"Robotic vs Laparoscopic Surgery for Middle and Low Rectal Cancer: The REAL Randomized Clinical Trial","volume":"334","author":"Feng","year":"2025","journal-title":"JAMA"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1245\/s10434-012-2270-1","article-title":"Robotic versus laparoscopic proctectomy for rectal cancer: A meta-analysis","volume":"19","author":"Memon","year":"2012","journal-title":"Ann. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Zou, J., Zhu, H., Tang, Y., Huang, Y., Chi, P., and Wang, X. (2025). Robotic versus laparoscopic surgery for rectal cancer: An updated systematic review and meta-analysis of randomized controlled trials. BMC Surg., 25.","DOI":"10.1186\/s12893-025-02805-z"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"15207","DOI":"10.1007\/s00432-023-05228-6","article-title":"Comparison of robotic-assisted versus conventional laparoscopic surgery for mid-low rectal cancer: A systematic review and meta-analysis","volume":"149","author":"Yao","year":"2023","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/SLA.0b013e3181b7fdb0","article-title":"The learning curve for the laparoscopic approach to conservative mesorectal excision for rectal cancer: Lessons drawn from a single institution\u2019s experience","volume":"251","author":"Bege","year":"2010","journal-title":"Ann. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s11605-008-0722-5","article-title":"Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer","volume":"13","author":"Park","year":"2009","journal-title":"J. Gastrointest. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1007\/BF02054118","article-title":"Laparoscopic-assisted colectomy learning curve","volume":"38","author":"Simons","year":"1995","journal-title":"Dis. Colon Rectum"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3297","DOI":"10.1007\/s00464-013-2909-4","article-title":"The multiphasic learning curve for robot-assisted rectal surgery","volume":"27","author":"Sng","year":"2013","journal-title":"Surg. Endosc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s00464-010-1281-x","article-title":"Learning curve for robotic-assisted laparoscopic colorectal surgery","volume":"25","author":"Bokhari","year":"2011","journal-title":"Surg. Endosc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2821","DOI":"10.1007\/s00464-014-3569-8","article-title":"Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison","volume":"28","author":"Park","year":"2014","journal-title":"Surg. Endosc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1186\/s13063-018-2726-0","article-title":"Exploring and adjusting for potential learning effects in ROLARR: A randomised controlled trial comparing robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection","volume":"19","author":"Corrigan","year":"2018","journal-title":"Trials"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s00384-016-2682-7","article-title":"Urogenital function in robotic vs laparoscopic rectal cancer surgery: A comparative study","volume":"32","author":"Panteleimonitis","year":"2017","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2485","DOI":"10.1245\/s10434-012-2262-1","article-title":"A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: Laparoscopic versus robotic surgery","volume":"19","author":"Kim","year":"2012","journal-title":"Ann. Surg. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e403","DOI":"10.1016\/S1470-2045(12)70236-X","article-title":"Anterior resection syndrome","volume":"13","author":"Bryant","year":"2012","journal-title":"Lancet Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.jss.2024.09.027","article-title":"By Any Other Name: Bowel Dysfunction After Proctectomy for Cancer and Its Predictive Factors in Administrative Databases","volume":"303","author":"Leeds","year":"2024","journal-title":"J. Surg. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e2659","DOI":"10.1002\/rcs.2659","article-title":"Comparing the long-term follow-up anal function between robot-assisted and laparoscopic surgery for low rectal cancer: A meta-analysis and systematic review","volume":"20","author":"Cao","year":"2024","journal-title":"Int. J. Med. Robot."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"109134","DOI":"10.1016\/j.surg.2024.109134","article-title":"Cost-effectiveness of robotic compared with laparoscopic rectal resection. Results from the Spanish prospective national trial ROBOCOSTES","volume":"180","author":"Pellino","year":"2025","journal-title":"Surgery"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e823","DOI":"10.1097\/MD.0000000000000823","article-title":"Cost-effectiveness of robotic surgery for rectal cancer focusing on short-term outcomes: A propensity score-matching analysis","volume":"94","author":"Kim","year":"2015","journal-title":"Medicine"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1002\/jso.24867","article-title":"Comparison of outcome and cost among open, laparoscopic, and robotic surgical treatments for rectal cancer: A propensity score matched analysis of nationwide inpatient sample data","volume":"117","author":"Chen","year":"2018","journal-title":"J. Surg. Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1007\/s11701-025-03114-6","article-title":"Economic assessment of next-generation robotic surgical systems compared with the multiport da Vinci platform: A comprehensive review","volume":"20","author":"Sighinolfi","year":"2026","journal-title":"J. Robot. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s10151-022-02703-z","article-title":"Index cost comparison of laparoscopic vs robotic surgery in colon and rectal cancer resection: A retrospective financial investigation of surgical methodology innovation at a single institution","volume":"27","author":"Ezeokoli","year":"2023","journal-title":"Tech. Coloproctology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s00384-023-04446-1","article-title":"Robotic versus laparoscopic proctectomy: A comparative study of short-term economic and clinical outcomes","volume":"38","author":"Larach","year":"2023","journal-title":"Int. J. Colorectal Dis."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/16\/2707\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:23:52Z","timestamp":1787300632000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/16\/2707"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":47,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["cancers18162707"],"URL":"https:\/\/doi.org\/10.3390\/cancers18162707","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]}}}