BACKGROUND: The usage of robotic surgery in rectal cancer was increasing, but there was an ongoing debate as to whether it provided any benefit. The aim of this study was to evaluate the safety, efficacy, and prognosis of elective rectal resection for rectal cancer by robotic surgery compared with conventional laparoscopic surgery. METHOD: Electronic databases were searched from their inception to 1 February 2024, for randomized controlled trials (RCTs) involving a comparison between robotic surgery (RS) and laparoscopic surgery (LS) and performed a meta-analysis of all RCTs according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTS: 11 RCTs including a total of 3107 cases were identified. Compared with LS, RS had a significantly lower conversion rate (odds ratio: 0.42
95% confidence interval: 0.28 to 0.63
P <
0.0002), lower reoperation rate (odds ratio: 0.454
95% confidence interval: 0.31 to 0.94
P = 0.03), more lymph nodes harvested (mean difference: 0.67
95% confidence interval: 0.30 to 1.04
P = 0.0004), a smaller incidence of positive circumferential margin (CRM) (odds ratio: 0.59
95% confidence interval: 0.41 to 0.85
P = 0.004). RS had less time to first autonomous urination (mean difference: -0.78
95% confidence interval: -1.15 to -0.41
P <
0.0002), less time to first defecation (mean difference: -0.40
95% confidence interval: -0.78 to -0.01
P = 0.04) and less time to first flatus (mean difference: -0.45
95% confidence interval: -0.89 to -0.01
P = 0.04), more operating time (mean difference: 23.46
95% confidence interval: 15.76 to 31.16
P <
0.00002). Overall postoperative complication, short-term postoperative complication, estimate blood loss, hospital stays, Intraoperative complication, postoperative mortality, preventive ostomy rates, readmission did not differ significantly between approaches. (P >
0.05). CONCLUSION: Compared to laparoscopic surgery, robotic surgery demonstrated superior safety, efficacy, and prognosis. This meta-analysis supports that RS is a safe and effective option.