Robotic ISR shows better anal function and fewer complications than laparoscopic approach

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Frontiers in Medicine Published May 22, 2026 Medically reviewed May 22, 2026 Study authors: Wenjie Zhou, Xueting Wang, Jie Dan, Mingjie Zhu, Qian Liao, Ming Li, Ke Liu, Yonghong Wang DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Robotic ISR may improve anal function and reduce complications versus laparoscopic ISR for low rectal cancer, but longer operation times and need for validation remain.

A systematic review and meta-analysis of 1,279 patients with low rectal cancer compared robotic and laparoscopic intersphincteric resection (ISR). The primary outcome was anal function, measured by Wexner scores, with secondary outcomes including rectal mesentery integrity, bleeding, complications, operation time, and oncological results.

Robotic ISR was associated with significantly better anal function, as shown by lower Wexner scores (MD = –1.46, 95%CI –2.03 to –0.88, p < 0.001). It also demonstrated superior rectal mesentery integrity (OR = 3.08, 95%CI 1.72–5.53, p = 0.0002), less intraoperative bleeding (MD = –11.47, 95%CI –17.25 to –5.68, p = 0.0001), and fewer postoperative complications (OR = 0.71, 95%CI 0.53–0.94, p = 0.02).

However, robotic ISR required longer operation times (MD = 0.76, 95%CI 0.62–0.91, p < 0.001). No significant differences were found in long-term oncological outcomes between the two approaches.

Limitations include potential biases from study design and sample size constraints. The findings suggest robotic ISR may offer clinical advantages in anal preservation and safety, but results require validation through randomized controlled trials.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Intersphincteric resection (ISR) is an important and challenging sphincter-preserving procedure for patients with low rectal cancer. Preserving anal function is more important than preserving its appearance. Owing to its unique advantages, the robotic platform makes ISR safer and less invasive. Whether this advantage is reflected in functional aspects is worth further exploration. PubMed, Cochrane Library and Embase were systematic researched for articles published relevant literature. The literature was screened independently by two groups, and data on functional, perioperative, and oncology outcomes were extracted and evaluated for bias. Meta-analysis was performed using Revman5.4 software. Ten studies with a total of 1279 patients were included in our meta-analysis, and Funnel plots suggested no major publication bias. The robotic ISR group had lower Wexner scores [MD = –1.46, 95%CI (–2.03 ∼–0.88), p < 0.001] than the laparoscopic ISR group, but with no significant difference compared to other functional outcomes. The robotic ISR group performed better in preserving the integrity of the rectal mesentery [OR = 3.08, 95%CI (1.72, 5.53), p = 0.0002], had less intraoperative bleeding [MD = –11.47, 95%CI (–17.25, –5.68), p = 0.0001], and had fewer postoperative complications [OR = 0.71, 95%CI (0.53, 0.94), p = 0.02], although the operation took longer [MD = 0.76, 95%CI (0.62∼0.91), p < 0.001]. No significant differences were observed in the long-term oncological outcomes between the two groups. Robotic ISR has potential advantages in preserving the anal function, with fewer complications and similar oncological outcomes compared with Laparoscopic ISR. Due to limitations in sample size and study design, the results of this study still require validation through randomized controlled trials. https://www.crd.york.ac.uk/PROSPERO, identifier CRD420251012991.