Original Title: Efficacité et innocuité de la chirurgie robotique : cancers du rectum et du côlon, tumeurs bénignes ou malignes du pancréas et obésité

Authors' objectives: The Ministère de la Santé et des Services sociaux’s Surgical Services Division (which has been transferred to Santé Québec) mandated the Institut national d’excellence en santé et en services sociaux to analyse the evidence regarding the effectiveness and safety of using robots in surgery for rectal and colon cancers, benign and malignant pancreatic tumours, and obesity. Prioritization was based on the requester’s needs, the availability of literature, and the growing use of robotic systems in Québec since 2018 for these indications.

Authors' results and conclusions: RESULTS (#1 ROBOTIC SURGERY: AN APPROACH AT LEAST COMPARABLE TO LAPAROSCOPIC SURGERY, TRANSANAL SURGERY AND OPEN SURGERY): The findings of this project are consistent with those of other health technology assessment agencies and are in line with the recommendations of learned societies and professional medical associations in colorectal and pancreatic surgery. (#2 KEY POINTS ABOUT ROBOTIC SURGERY FOR RECTAL CANCER): Robotic surgery appears to be comparable to the laparoscopic, transanal and/or open approaches in terms of: • The probability of postoperative complications of any severity and of anastomotic leaks, and the estimated blood loss (all comparisons) (#3 KEY POINTS ABOUT ROBOTIC SURGERY FOR COLON CANCER): In individuals with colon cancer, robotic surgery was comparable to laparoscopic surgery for 6 of them, namely: • The probability of postoperative complications of any severity and of major postoperative complications, of anastomotic leaks, of disease-free survival, as well as the length of hospital stay and estimated blood loss. However, compared to laparoscopic surgery, robotic surgery may lead to a relative reduction in the risk of conversion to open surgery (level of scientific evidence: very low). (#4 KEY POINTS ABOUT ROBOTIC DISTAL PANCREATECTOMY FOR BENIGN AND MALIGNANT PANCREATIC TUMOURS): Robotic distal pancreatectomy appears to be comparable to the laparoscopic and/or open approaches in terms of: • The probability of positive surgical margins, of major postoperative complications and of major postoperative pancreatic fistulas and of postoperative pancreatic fistulas of any severity (all comparisons). (#5 KEY POINTS ABOUT ROBOTIC WHIPPLE SURGERY FOR BENIGN AND MALIGNANT PANCREATIC TUMOURS): Robotic Whipple surgery appears to be comparable to laparoscopic and/or open approaches in terms of: The probability of major postoperative pancreatic fistulas (compared to open surgery. (#6 KEY POINTS ABOUT ROUX-EN-Y GASTRIC BYPASS SURGERY FOR OBESITY): In individuals with obesity, robotic surgery was comparable to laparoscopic surgery for all the outcomes evaluated. • Robotic Roux-en-Y gastric bypass surgery (robot used for all or part of the procedure) appears to be comparable to laparoscopic surgery with regard to the probability of hospital readmission (for any reason), of postoperative complications of any severity, of conversion to open surgery, of anastomotic leaks and of reoperation, and to the length of hospital stay and the estimated blood loss. (#7 KEY POINTS ABOUT SLEEVE GASTRECTOMY FOR OBESITY): In individuals with obesity, robotic surgery was comparable to laparoscopic surgery for all of the outcomes evaluated, namely, the probability of hospital readmission for any reason, of postoperative complications of any severity, of staple line leaks and of reoperation, and the length of hospital stay. CONCLUSION: The analysis shows that robotic surgery is at least comparable to laparoscopic surgery, transanal surgery and open surgery in terms of safety, clinical and organizational effectiveness for the five indications of interest. However, certain outcomes suggest potential benefits for four of the indications (rectal and colon cancers, and benign and malignant pancreatic tumours), with levels of scientific evidence ranging from very low to moderate, while there are no data to support superiority regarding obesity.

Authors' methods: The reference lists of the selected publications were also reviewed to identify additional relevant publications. Publications in both French and English were selected. In addition, to narrow and contextualize the analysis, outcomes deemed important for assessing the clinical and organizational value of robotic surgery were identified prior to the analysis, and significance thresholds were assigned to them with the help of general surgeons and surgeons from different specialties, including colorectal, bariatric, pancreatic and cancer surgeons. Two scientific professionals took part in selecting publications, extracting data, and assessing the risk of bias and levels of scientific evidence.

Project Status: Completed

Year Published: 2026

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/Chirurgie_robotique_cancer_rectum_colon_pancreas_EC_INESSS.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)