Colorectal surgery has undergone significant advances over the past few decades, driven by the evolution of minimally invasive techniques, particularly laparoscopy and robotics. While laparoscopy is widely recognized for its short-term benefits and oncological safety, the increasing adoption of robot-assisted surgery (RAS) has generated considerable debate regarding its clinical benefits, economic implications, and overall impact on patient outcomes. This narrative review synthesizes the existing evidence, highlighting the clinical and economic aspects of RAS in colorectal surgery, while exploring areas for future research. The findings suggest that RAS offers potential technical advantages, including increased precision, three-dimensional visualization, and improved ergonomics, particularly in anatomically complex scenarios such as low rectal resections. Still, its superiority over laparoscopy remains inconclusive and current evidence is mixed. For colon cancer, meta-analyses and analyses of large cohorts suggest lower conversion rates and faster recovery with RAS, although data are mostly retrospective and lack long-term oncological endpoints. In rectal cancer, emerging evidence from randomized controlled trials demonstrates improved short-term outcomes. Additionally, the recently published three-year results of the REAL trial are the first to demonstrate enhanced oncological outcomes following RAS. However, findings remain inconsistent due to methodological heterogeneity, the absence of patient stratification, and limited data on long-term survival and cost-effectiveness. The available evidence indicates that RAS may offer advantages in selected patient populations, particularly for anatomically complex procedures. Yet, its overall utility remains uncertain. Future studies should emphasize high-quality randomized trials, stratified subgroup analyses, and standardized economic evaluations to better define the role of RAS in colorectal surgery.
在过去的几十年里，结直肠外科手术取得了显著进展，这主要得益于微创技术的演进，特别是腹腔镜和机器人手术的普及。尽管腹腔镜手术因其短期获益和肿瘤学安全性得到广泛认可，但机器人辅助手术（RAS）的日益普及引发了关于其临床获益、经济影响以及对患者结局整体影响的广泛讨论。本文通过叙述性综述整合现有证据，重点探讨RAS在结直肠手术中的临床与经济层面，并展望未来研究方向。研究显示，RAS在技术上具有潜在优势，包括更高的操作精度、三维可视化效果以及更优的人体工程学设计，尤其在低位直肠切除术等解剖结构复杂的手术中表现突出。然而，其相对于腹腔镜手术的优越性尚未定论，现有证据结论不一。针对结肠癌，多项荟萃分析和大规模队列研究表明，RAS能降低中转开腹率并加快术后恢复，但相关数据多源于回顾性研究，且缺乏长期肿瘤学终点数据。在直肠癌领域，新近随机对照试验的证据显示RAS可改善短期结局。此外，近期发表的REAL试验三年随访结果首次证实RAS能提升肿瘤学结局。然而，由于研究方法存在异质性、缺乏患者分层分析以及长期生存数据和成本效益证据有限，现有研究结论仍不一致。现有证据表明，RAS可能对特定患者群体（尤其是解剖结构复杂的手术）具有优势，但其整体临床价值仍不明确。未来研究应聚焦高质量随机试验、分层亚组分析及标准化经济学评估，以进一步明确RAS在结直肠外科中的定位。
肿瘤(癌症)患者之家