Robotic versus laparoscopic surgery for rectal cancer: an overview of systematic reviews with quality assessment of current evidence.

The clinical benefits of robotic surgery for patients with rectal cancer have been reported and many systematic reviews have been published. However, they have investigated a variety of outcomes and differ remarkably in quality. In this overview, we summarize the findings of these reviews and evaluate their quality. The PubMed, Scopus, and Cochrane Central Register of Controlled Trials databases were comprehensively searched to identify systematic reviews and meta-analyses that compared robotic and laparoscopic surgery. We assessed the quality of the reviews using the AMSTAR-2 tool. The literature search identified 17 eligible reviews, all of which reported that the incidence of conversion to open surgery was lower for robotic surgery than for laparoscopic surgery. Most of the reviews reported no difference in the other outcomes between robotic surgery and laparoscopic surgery. However, the quality of the reviews was judged to be low or critically low. Critically low quality evidence suggests that robotic surgery for rectal cancer decreases the likelihood of conversion to open surgery, but other clinical benefits remain unclear. High-quality systematic reviews in which selection of high-quality studies is combined with adequate methodology are needed to clarify the true efficacy of robotic surgery for rectal cancer.