Introduction <p>Accurate pedicle screw placement is critical in spinal tumor and metastasis surgery to ensure stability while minimizing complications. Robot-assisted (RA) techniques have been introduced to improve precision, but their benefits over traditional freehand methods remain uncertain. This study systematically reviews and meta-analyzes the accuracy, safety, and efficiency of RA versus freehand pedicle screw placement in patients with spinal tumors and metastases.</p> Methods <p>A systematic search was conducted across five databases. Studies comparing RA and freehand pedicle screw placement in spinal tumor patients were included. Primary outcomes assessed screw accuracy using the Gertzbein–Robbins (GR) classification, while secondary outcomes included operative time, infection rates, and neurological complications. Data were pooled using odds ratios (OR) and mean differences (MD) with a random-effects model.</p> Results <p>Three studies were included. RA significantly improved screw placement accuracy (GR A: 76.1% vs. 70.3%, OR 1.34, <i>p</i> = 0.023) and reduced minimally misplaced screws (GR B, OR 0.69, <i>p</i> = 0.010). The total percentage of clinically acceptable screws (GR A + B) was comparable between groups (90.9% vs. 90.7%, <i>p</i> = 0.953). RA surgery significantly reduced operative time (MD − 19.24&#xa0;min, <i>p</i> &lt; 0.01), while infection rates and neurological complications showed no significant differences.</p> Conclusion <p>RA pedicle screw placement showed a trend toward a higher rate of perfectly placed screws (GR A), though this was not confirmed by trial sequential analysis. Overall safety profiles were comparable. Further research is needed to evaluate the long-term outcomes and cost-effectiveness of spinal oncology surgery.</p>