Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2018; 10(11): 449-464
Published online Nov 15, 2018. doi: 10.4251/wjgo.v10.i11.449
Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial
Katie Jones, Mohamed G Qassem, Parv Sains, Mirza K Baig, Muhammad S Sajid
Katie Jones, Mohamed G Qassem, Parv Sains, Muhammad S Sajid, Department of General and Laparoscopic Colorectal Surgery, Brighton and Sussex University Hospitals NHS Trust, the Royal Sussex County Hospital, Brighton, West Sussex BN2 5BE, United Kingdom
Mohamed G Qassem, Lecturer of General Surgery, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
Mirza K Baig, Department of General and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, West Sussex BN11 2DH, United Kingdom
Author contributions: Jones K contributed to literature search, data extraction, manuscript writing and approval; Qassem MG contributed to data extraction, data confirmation, manuscript writing and approval; Sains P contributed to data confirmation, data interpretation, manuscript writing and approval; Baig MK contributed to data interpretation, data confirmation, manuscript writing and approval; Sajid MS contributed to idea conception, literature search, study selection, data analysis, data interpretation, manuscript writing and approval.
Conflict-of-interest statement: None to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Muhammad S Sajid, BM BCh, FCPS, FRCS (Ed), FRCS (Gen Surg), MBBS, MSc, Attending Doctor, Research Fellow, Surgeon, Department of General and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex BN11 2DH, United Kingdom.
Telephone: +44-1273-696955 Fax: +44-7891-667608
Received: April 16, 2018
Peer-review started: April 17, 2018
First decision: May 17, 2018
Revised: June 25, 2018
Accepted: June 28, 2018
Article in press: June 29, 2018
Published online: November 15, 2018

To compare outcomes in patients undergoing rectal resection by robotic total meso-rectal excision (RTME) vs laparoscopic total meso-rectal excision (LTME).


Standard medical electronic databases such as PubMed, MEDLINE, EMBASE and Scopus were searched to find relevant articles. The data retrieved from all types of included published comparative trials in patients undergoing RTME vs LTME was analysed using the principles of meta-analysis. The operative, post-operative and oncological outcomes were evaluated to assess the effectiveness of both techniques of TME. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR).


One RCT (ROLARR trial) and 27 other comparative studies reporting the non-oncological and oncological outcomes following RTME vs LTME were included in this review. In the random effects model analysis using the statistical software Review Manager 5.3, the RTME was associated with longer operation time (SMD, 0.46; 95%CI: 0.25, 0.67; z = 4.33; P = 0.0001), early passage of first flatus (P = 0.002), lower risk of conversion (P = 0.00001) and shorter hospitalization (P = 0.01). The statistical equivalence was seen between RTME and LTME for non-oncological variables like blood loss, morbidity, mortality and re-operation risk. The oncological variables such as recurrence (P = 0.96), number of harvested nodes (P = 0.49) and positive circumferential resection margin risk (P = 0.53) were also comparable in both groups. The length of distal resection margins was similar in both groups.


RTME is feasible and oncologically safe but failed to demonstrate any superiority over LTME for many surgical outcomes except early passage of flatus, lower risk of conversion and shorter hospitalization.

Keywords: Diverticular disease, Colorectal resections, Multi-incision laparoscopic surgery, Colorectal cancer, Single incision laparoscopic surgery

Core tip: The findings of this meta-analysis of one RCT and 27 case control studies on 5547 patients are consistent with the recently published ROLARR trial validating the feasibility and oncological safety of robotic total meso-rectal excision (RTME). However, RTME failed to demonstrate any superiority over laparoscopic total meso-rectal excision except reduced conversion rate.