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33 [0.24, 0.46], p less then 0.001). Operative time in the LTME cohort was significantly reduced by 50 minutes compared with the RTME cohort. Subgroup analysis of the three randomised controlled trials (RCTs) challenged all the significant results of the main analysis and demonstrated non-significant differences between the RTME cohort and LTME cohort. CONCLUSIONS Although the RTME cohort included patients with significantly higher BMI, more distal tumours, and more patients undergoing neoadjuvant therapy, this cohort demonstrated lower conversion r