Robot-assisted total mesorectal excision (R-TME) significantly increases the likelihood of achieving primary anastomosis compared to laparoscopic TME (L-TME), with an odds ratio of 1.43.

• R-TME shows even stronger results in studies conducted after 2020, doubling the odds ratio to 2.86.
• There are no significant differences in complication rates, including anastomotic leaks or readmissions, between R-TME and L-TME.

Surgeons should consider R-TME for eligible rectal cancer patients, as it may enhance restorative surgical options without increasing risks.