Comparação entre Cirurgia Robótica e Laparoscópica para Câncer Retal: Evidências Atuais sobre Resultados Funcionais e Oncológicos

Abstract

Introduction: Colorectal cancer remains a global challenge, with high incidence and mortality, often associated with synchronous liver metastases. Minimally invasive surgery, particularly robotic surgery, has emerged as a technique that enhances precision, three-dimensional visualization, and functional preservation, offering reduced blood loss, fewer complications, and faster recovery. However, evidence of definitive clinical benefits regarding urinary and sexual function and quality of life remains limited. Robust randomized trials and systematic reviews are needed to establish the true impact of robotic surgery in rectal cancer treatment. Objectives: To comparatively evaluate the clinical, functional, and oncological outcomes of robotic versus laparoscopic surgery in rectal cancer treatment. Methodology: This literature review analyzed publications from 2016 to 2025 on robotic and laparoscopic rectal cancer surgery, using international databases such as PubMed and Embase. Peer-reviewed studies in English reporting functional and oncological outcomes, perioperative complications, and recurrence were included. Results and Discussion: Robotic surgery for rectal cancer demonstrates technical advantages, including greater precision, three-dimensional visualization, and improved ergonomics, facilitating complex dissections and functional preservation, especially in low tumors and male or obese patients. However, clinical trials, including the largest available RCT, did not show significant differences in conversion to laparotomy, complications, or quality of life. Limitations include a single-center setting, only two surgeons, small subgroups, and potential allocation bias. Furthermore, robotic surgery is not cost-effective, though oncological outcomes remain comparable. Conclusion: Robotic surgery for rectal cancer is safe and technically advantageous but does not provide significant benefits over laparoscopy in terms of conversion rates, survival, or quality of life, highlighting the need for cost assessment, patient selection, and specialized surgical training.