Robotic versus laparoscopic left-sided colectomy: a propensity-matched analysis of surgical outcomes, oncologic efficacy, and cost-effectiveness.

Anastomotic leakage (AL) remains a critical complication following left-sided colectomy, with severe leaks (Grade C) significantly increasing mortality and healthcare costs. Robotic surgery offers technical advantages, but large-scale comparative data on AL severity, survival, and cost-effectiveness are limited. Using a national registry (2014-2025), 2916 robotic and laparoscopic left colectomy cases were 1:1 propensity-matched for age, sex, BMI, ASA class, tumor location, and operative year. Outcomes included AL severity (Colorectal Leakage Score), conversion rates, lymph node yield, survival, and cost-effectiveness. Robotic procedures increased from 8% (2014) to 35% (2025; p < 0.001). Compared to laparoscopy, robotics reduced conversion rates by 58% (4.2% vs. 9.8%; p < 0.001) and AL by 42% (4.5% vs. 7.8%), with a 51% reduction in Grade C leaks (1.2% vs. 2.1%). Robotic cases had higher lymph node yields (28 vs. 24 nodes; p < 0.001), wider margins (8.5 vs. 6.3 mm; p = 0.002), and improved 5-year survival (78.2% vs. 74.5%). Despite 18% higher upfront costs ($14,200 vs. $12,050), robotics saved $3850 per patient in complication-related costs, yielding an ICER of $28,500/QALY. Robotic left colectomy reduces severe AL, improves oncologic outcomes, and is cost-effective. The benefits are most pronounced in advanced-stage and technically challenging cases, supporting selective adoption in universal healthcare systems.