Robotic versus laparoscopic right hemicolectomy for right-sided colon cancer: an updated systematic review and meta-analysis of long-term oncological outcomes
TL;DR
It is suggested that RRH represents a safe and oncologically sound alternative to laparoscopy providing comparable long-term oncological outcomes and suggesting possible additional benefits in favor of RRH.
Abstract
Robotic right hemicolectomy (RRH) has progressively emerged as a valid alternative minimally invasive approach to laparoscopic right hemicolectomy (LRH). Perioperative outcomes of RRH and LRH have been largely investigated. Aim of this study was to compare long-term survival outcomes in patients undergone RRH versus LRH for right-sided colon cancer. A systematic review and meta-analysis were performed searching PubMed, Embase, Scopus, and Web of Science databases to identify studies comparing RRH versus LRH for right-sided colon cancer through December 2025 (PROSPERO registration: CRD420261372273). Risk of bias for non-randomized studies was assessed using the Newcastle–Ottawa Scale, while Cochrane Risk of Bias 2.0 was used for randomized controlled trials (RCT). Overall survival (OS) and disease-free survival (DFS) outcomes were pooled as hazard ratios (HRs) with 95% confidence intervals (CIs). Time-specific survival outcomes were analyzed as relative risks (RRs). Predefined subgroup analyses were performed for studies reporting complete mesocolic excision (CME), and sensitivity analyses were conducted in propensity score–matched (PSM) cohorts and contemporary-era studies. Ten studies comprising 1,575 patients (716 RRH and 859 LRH) were included. Pooled time-to-event analyses demonstrated no significant difference between RRH and LRH in DFS (HR 0.91, 95% CI 0.72–1.15; P = 0.410) or OS (HR 1.11, 95% CI 0.84–1.41; P = 0.378). Similarly, no significant difference were observed in 1-, 3-, or 5-year DFS and OS analyses; however, all pooled RRs were consistently greater than 1, indicating a numerical trend favoring RRH. Finally, comparable outcomes were confirmed across CME studies, PSM cohorts, and studies representative of the contemporary robotic era. RRH provides long-term oncological outcomes comparable to those achieved with LRH for right-sided colon cancer. Despite the technical and perioperative advantages associated with robotic surgery, these did not translate into significant improvements in DFS or OS. These findings suggest that RRH represents a safe and oncologically sound alternative to laparoscopy providing comparable long-term oncological outcomes and suggesting possible additional benefits in favor of RRH.