Background: To some extent, the robotic technique does offer certain benefits in rectal cancer surgery than laparoscopic one, while remains a topic of ongoing debate for rectal cancer patients who have undergone neoadjuvant chemoradiotherapy (NCRT). Methods: Potential studies published until January 2024 were obtained from Web of Science, Cochrane Library, Embase, and PubMed. Dichotomous and continuous variables were expressed as odds ratios (ORs) or weighted mean differences (WMDs) with 95% CIs, respectively. A random effects model was used if the I ² statistic >50%; otherwise, a fixed effects model was used. Results: Eleven studies involving 1079 patients were analysed. The robotic-assisted group had an 0.4 cm shorter distance from the anal verge (95% CI: −0.680 to −0.114, P =0.006) and 1.94 times higher complete total mesorectal excision (TME) rate (OR=1.936, 95% CI: 1.061–3.532, P =0.031). However, the operation time in the robotic-assisted group was 54 min longer (95% CI: 20.489–87.037, P =0.002) than the laparoscopic group. In addition, the robotic-assisted group had a lower open conversion rate (OR=0.324, 95% CI: 0.129–0.816, P =0.017) and a shorter length of hospital stay (WMD=−1.127, 95% CI: −2.071 to −0.184, P =0.019). Conclusion: Robot-assisted surgery offered several advantages over laparoscopic surgery for locally advanced mid-low rectal cancer following NCRT in terms of resection of lower tumours with improved TME completeness, lower open conversion rate, and shorter hospital stay, despite the longer operative time.

Background: The albumin-to-alkaline phosphatase ratio (AAPR), a simple and cost-effective prognostic parameter, has not been thoroughly investigated in relation to gastrointestinal (GI) cancers. Methods: Relevant studies were retrieved from databases including Web of Science, Cochrane Library, Embase, and PubMed up to February 2025. Survival outcomes were presented as hazard ratios (HRs) with 95% confidence intervals (CIs). Heterogeneity was evaluated using the I ² statistic and Cochrane’s Q test. When significant heterogeneity was detected ( I ² ≥ 50% or P ≤ 0.05), a random-effects model was employed; otherwise, a fixed-effects model was utilized. Statistical analyses were conducted using STATA 18.0 software. Results: Eight studies involving 2267 patients with GI cancer were analysed. The pooled results of overall survival (OS) from both univariate and multivariate analyses indicated a significantly higher risk of death in the low-AAPR group than in the high-AAPR group (HR = 2.49, 95% CI: 1.67 to 3.71, P < 0.001, I ² = 84.3%; HR = 2.59, 95% CI: 1.55 to 4.35, P < 0.001, I ² = 80.3%). For recurrence-free survival (RFS), univariate analysis revealed worse outcomes in the low-AAPR group (HR = 1.58, 95% CI: 1.18 to 2.13, P = 0.002, I ² = 0.0%). However, multivariate analysis did not establish a significant correlation between the two groups (HR = 1.25, 95% CI: 0.33 to 4.77, P = 0.740, I ² = 51.5%). Subgroup analyses by country, tumor type, treatment method, and AAPR cut-off value consistently showed that low AAPR was significantly associated with poor OS. Although publication bias was detected in the OS meta-analysis, both the trim-and-fill method and sensitivity analysis confirmed a significant association between low AAPR and poor OS. Conclusion: A low AAPR is associated with poorer OS in GI cancer patients. Therefore, AAPR may serve as a promising serological parameter for prognostic assessment in GI cancer patients.