{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:30:34Z","timestamp":1787315434696,"version":"build-2736575974"},"reference-count":39,"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\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Intersphincteric resection (ISR) is a technically demanding sphincter-preserving procedure for low rectal cancer. While robotic surgery may offer technical advantages, evidence comparing robotic ISR (R-ISR) and laparoscopic ISR (L-ISR) remains limited. This study aimed to compare perioperative, oncologic, and functional outcomes between R-ISR and L-ISR. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020. PubMed, Scopus, and Cochrane Library were searched up to 1 March 2026. Comparative studies evaluating R-ISR versus L-ISR in adult patients with low rectal cancer were included. Random-effects models were used to calculate mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I2. Subgroup and sensitivity analyses were performed. Results: Seven studies were included. R-ISR was associated with a significantly longer operative duration (MD 34.53 min, 95% CI 7.48 to 61.59; p = 0.02; I2 = 81%), a lower rate of overall complications (OR 0.78, 95% CI 0.61 to 0.99; p = 0.04; I2 = 0%), a statistically lower Wexner score at 12 months, although the magnitude of the difference was small and its clinical significance uncertain (MD \u22121.53, 95% CI \u22122.54 to \u22120.51; p = 0.02; I2 = 0%), and a slightly lower lymph node yield (MD \u22121.06, 95% CI \u22122.05 to \u22120.08; p = 0.04; I2 = 65%). No significant differences were observed in blood loss (MD \u22128.15, 95% CI \u221223.03 to 6.73; p = 0.20; I2 = 37%), conversion to open surgery (OR 0.35, 95% CI 0.02 to 6.02; p = 0.13; I2 = 0%), anastomotic leakage (OR 0.92, 95% CI 0.61 to 1.37; p = 0.60; I2 = 0%), length of hospital stay (MD \u22120.48, 95% CI \u22121.16 to 0.21; p = 0.12; I2 = 0%), and CRM positivity (OR 0.93, 95% CI 0.01 to 69.04; p = 0.87; I2 = 0%). Subgroup analyses in experienced surgeons and high-volume centers demonstrated no statistically significant differences across outcomes. Sensitivity analyses showed that several results were not robust. Conclusions: Evidence to date does not show superiority of robotic or laparoscopic ISR. Robotic ISR was associated with longer operative time and lower overall complication rates but most perioperative and oncologic outcomes were comparable. After robotic ISR, the 12-month Wexner scores were statistically lower, although the magnitude of this difference was small and the clinical significance uncertain. These results should be interpreted with caution given the limited non-randomized evidence base. PROSPERO Registration: CRD420261359130.<\/jats:p>","DOI":"10.3390\/jcm15166483","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:37:34Z","timestamp":1787312254000},"page":"6483","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Perioperative, Oncologic, and Functional Outcomes Following Robotic and Laparoscopic Intersphincteric Resection for Low Rectal Cancer: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Konstantinos","family":"Kossenas","sequence":"first","affiliation":[{"name":"Second Propedeutic Department of Surgery, Laiko General Hospital, National Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9157-9860","authenticated-orcid":false,"given":"Maximos","family":"Frountzas","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Royal Marsden Hospital, NHS Foundation Trust, London SW3 6JJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5053-0953","authenticated-orcid":false,"given":"Athanasios","family":"Syllaios","sequence":"additional","affiliation":[{"name":"Colorectal Department, Addenbrooke\u2019s Hospital, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3824-0969","authenticated-orcid":false,"given":"Nikolaos","family":"Pararas","sequence":"additional","affiliation":[{"name":"Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4267-6813","authenticated-orcid":false,"given":"Panagiotis","family":"Kokoropoulos","sequence":"additional","affiliation":[{"name":"Fourth Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7182-2664","authenticated-orcid":false,"given":"Dimosthenis","family":"Michelakis","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, University General Hospital of Heraklion, University of Crete, 71500 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4390-3029","authenticated-orcid":false,"given":"Konstantinos","family":"Tsimogiannis","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, St Luke\u2019s Hospital, 55236 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0867-3213","authenticated-orcid":false,"given":"Dimitrios","family":"Symeonidis","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7046-0112","authenticated-orcid":false,"given":"Dimitrios","family":"Schizas","sequence":"additional","affiliation":[{"name":"First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s11701-025-02375-5","article-title":"Short-term clinical outcomes of open, laparoscopic, and robotic-assisted rectal resections: A multicenter real-world evidence study from Indian collaborative group on rectal resections (ICGRR)","volume":"19","author":"Ramakrishnan","year":"2025","journal-title":"J. Robot. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1007\/s11701-025-02936-8","article-title":"Robotic rectal cancer surgery in a medium-volume center: Oncologic and functional outcomes of an 8-year experience","volume":"19","author":"Gatto","year":"2025","journal-title":"J. Robot. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1007\/s11701-024-01922-w","article-title":"Perioperative and long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision: A retrospective study of 672 patients","volume":"18","author":"Shadmanov","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.lers.2023.04.001","article-title":"Intersphincteric resection and coloanal anastomosis in the treatment of distal rectal cancers","volume":"6","author":"Puntambekar","year":"2023","journal-title":"Laparosc. Endosc. Robot. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"351","DOI":"10.3393\/ac.2021.00836.0119","article-title":"Robotic intersphincteric resection for low rectal cancer: Technical controversies and a systematic review on the perioperative, oncological, and functional outcomes","volume":"37","author":"Piozzi","year":"2021","journal-title":"Ann. Coloproctol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1055\/s-0037-1606114","article-title":"Intersphincteric resection pushing the envelope for sphincter preservation","volume":"30","author":"Denost","year":"2017","journal-title":"Clin. Colon. Rectal. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s11701-025-02358-6","article-title":"Comparison of surgical outcomes between robotic and laparoscopic surgery for mid-low rectal cancer: A meta-analysis of randomized controlled trials","volume":"19","author":"Li","year":"2025","journal-title":"J. Robot. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e22718","DOI":"10.1097\/MD.0000000000022718","article-title":"Laparoscopic vs. open colorectal surgery: Economic and clinical outcomes in the Brazilian healthcare","volume":"99","author":"Ribeiro","year":"2020","journal-title":"Medicine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1007\/s11701-024-02095-2","article-title":"Advantages of robotic surgery for rectal cancer compared to laparoscopic surgery: Pelvic anatomy and its impact on urinary dysfunction","volume":"18","author":"Takashima","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s11701-024-01894-x","article-title":"Long-term outcomes of robot-assisted laparoscopic surgery versus conventional laparoscopic surgery for rectal cancer: Single-center, retrospective, propensity score analyses","volume":"18","author":"Mazaki","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/s11701-024-02136-w","article-title":"Experiences in robotic colorectal surgery: Comprehensive insights from a multi-center analysis using the Senhance robotic system","volume":"18","author":"Samalavicius","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/s11701-024-01908-8","article-title":"Outcomes in robotic-assisted compared to laparoscopic-assisted colorectal surgery in a newly established colorectal tertiary center: A retrospective comparative cohort study","volume":"18","author":"Alkhamis","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s11701-025-03137-z","article-title":"Open, laparoscopic, and robotic approaches in colorectal surgery: A comprehensive review with focus on colorectal cancer","volume":"20","author":"Shafiei","year":"2026","journal-title":"J. Robot. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s11701-024-01934-6","article-title":"A systematic review and meta-analysis of short-term outcomes comparing the efficacy of robotic versus laparoscopic colorectal surgery in obese patients","volume":"18","author":"Chen","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1007\/s11701-025-02838-9","article-title":"Mapping the knowledge landscape of robotic colorectal cancer surgery: A visualization study","volume":"19","author":"Li","year":"2025","journal-title":"J. Robot. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s11701-025-02628-3","article-title":"Robotic versus laparoscopic surgery for rectal cancer: A systematic review and meta-analysis of randomized trials evaluating functional recovery, complication risk, and oncologic quality","volume":"19","author":"Mirza","year":"2025","journal-title":"J. Robot. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1007\/s11701-024-01945-3","article-title":"Comparison of robotic versus laparoscopic surgery for visceral obesity in mid\u2013low rectal cancer: A propensity-matched analysis","volume":"18","author":"Zhao","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1007\/s11701-025-02755-x","article-title":"Robotic versus laparoscopic total mesorectal excision for mid\u2013low rectal cancer after neoadjuvant chemoradiotherapy: A systematic review and meta-analysis of oncological, perioperative, and survival-related outcomes","volume":"19","author":"Liu","year":"2025","journal-title":"J. Robot. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1007\/s11701-026-03254-3","article-title":"Development and validation of a predictive model for postoperative urinary dysfunction following robotic total mesorectal excision in mid-low rectal cancer","volume":"20","author":"Jiang","year":"2026","journal-title":"J. Robot. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s11701-007-0015-0","article-title":"Robotic total mesorectal excision for the treatment of rectal cancer","volume":"1","author":"Baik","year":"2007","journal-title":"J. Robot. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_23","unstructured":"Higgins, J., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M., Welch, V., and Flemyng, E. (2024). Cochrane Handbook for Systematic Reviews of Interventions Version 6.5 (Updated August 2024), Cochrane. Available online: www.cochrane.org\/handbook."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_25","unstructured":"(Review Manager (RevMan), 2024). Review Manager (RevMan), Version 7.2.0."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-135"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Zhu, H., Zou, J., Pan, H., Huang, Y., and Chi, P. (2025). Comparison of laparoscopic versus robot-assisted surgery for rectal cancer after neoadjuvant therapy: A large volume single center experience. BMC Surg., 25.","DOI":"10.1186\/s12893-025-02764-5"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1007\/s00384-025-04844-7","article-title":"Long-term functional and prognostic outcomes of robotic intersphincteric resection for treating low rectal cancer: A single-center retrospective study","volume":"40","author":"Bo","year":"2025","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"60","DOI":"10.4103\/jmas.jmas_320_23","article-title":"Robotic versus laparoscopic intersphincteric resection for patients with low rectal cancer: Short-term outcomes","volume":"21","author":"Ge","year":"2025","journal-title":"J. Minimal Access Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s11701-024-01826-9","article-title":"Sphincter-preserving effect of robotic-assisted intersphincteric resection for ultra-low rectal cancer: A propensity score matching analysis","volume":"18","author":"Sun","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1007\/s13304-022-01396-1","article-title":"Robotic vs. laparoscopic intersphincteric resection for low rectal cancer: A case matched study reporting a median of 7-year long-term oncological and functional outcomes","volume":"74","author":"Aliyev","year":"2022","journal-title":"Updates Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.ejso.2022.07.009","article-title":"Functional outcomes after robotic or laparoscopic intersphincteric resection: An inverse probability weighting analysis","volume":"49","author":"Kazi","year":"2023","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_33","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_34","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Dimitrijevic, I., Miladinov, M., Jelenkovic, J., Gavrilovic, P., Sekulic, A., Barisic, G., and Stojkovic, J.R. (2026). Open vs. laparoscopic surgery for rectal cancer: Impact on identification and preservation of pelvic autonomic nerves and effects on urinary and sexual function and quality of life. J. Clin. Med., 15.","DOI":"10.3390\/jcm15062421"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"zraf111","DOI":"10.1093\/bjsopen\/zraf111","article-title":"Transanal versus transabdominal total mesorectal excision for rectal cancer in minimally invasive surgery: Meta-analysis","volume":"9","author":"Liao","year":"2025","journal-title":"BJS Open"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Madarasz, Z., Leitz, M., Vladimirov, M., Baginski, K., Hoyer, A., Hoeppner, J., Nimczewski, F., and Nowakowski, K. (2025). Robotic versus laparoscopic versus open surgery for rectal cancer. J. Clin. Med., 14.","DOI":"10.3390\/jcm14196743"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Zhang, J., Qi, X., Yi, F., Cao, R., Gao, G., and Zhang, C. (2021). Comparison of clinical efficacy and safety between da Vinci robotic and laparoscopic intersphincteric resection for low rectal cancer: A meta-analysis. Front. Surg., 8.","DOI":"10.3389\/fsurg.2021.752009"},{"key":"ref_39","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."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6483\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:59:44Z","timestamp":1787313584000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":39,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166483"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166483","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]}}}