Robotic versus laparoscopic resection for transverse colon and splenic flexure cancer: a systematic review and meta-analysis.

Transverse colon and splenic flexure cancer resections are technically demanding because of variable vascular anatomy, multiquadrant dissection, and proximity to the pancreas and spleen. This systematic review and meta-analysis compared robotic and laparoscopic outcomes and separately summarized published robotic experience. MEDLINE/PubMed, Embase/Ovid, Scopus, and the Cochrane Database of Systematic Reviews were searched through 18 July 2026. Six non-randomized comparative studies included 167 robotic and 296 laparoscopic patients. Overall morbidity (risk ratio [RR] 1.02, 95% confidence interval [CI] 0.72-1.45), major morbidity (RR 0.61, 95% CI 0.27-1.34), anastomotic leakage (RR 0.62, 95% CI 0.22-1.79), reoperation, and lymph-node yield did not differ significantly. Conversion occurred in 0 of 149 robotic and 14 of 278 laparoscopic procedures (Peto odds ratio 0.19, 95% CI 0.06-0.62), although events were sparse. Robotic surgery was associated with a shorter hospital stay (mean difference - 1.01 days, 95% CI -1.66 to -0.37), whereas operative time was highly heterogeneous. Across 10 robotic cohorts comprising 201 patients, pooled overall morbidity was 22.4%, major morbidity 4.9%, anastomotic leakage 3.0%, and R0 resection 98.4%; no 30-day death occurred among 183 reporting patients. Robotic resection is feasible and provides short-term and pathological outcomes comparable with laparoscopy. The shorter hospital stay and lower observed conversion rate suggest clinical advantages, supporting robotic surgery as a valuable minimally invasive option in experienced centers while awaiting confirmation from standardized prospective studies.