Comparison of Perioperative, Oncologic, and Functional Outcomes Following Robotic and Laparoscopic Intersphincteric Resection for Low Rectal Cancer: A Systematic Review and Meta-Analysis.

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 -1.53, 95% CI -2.54 to -0.51; p = 0.02; I2 = 0%), and a slightly lower lymph node yield (MD -1.06, 95% CI -2.05 to -0.08; p = 0.04; I2 = 65%). No significant differences were observed in blood loss (MD -8.15, 95% CI -23.03 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 -0.48, 95% CI -1.16 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.