Robot-Assisted Versus Conventional Laparoscopic Surgery for Colorectal Disease, Focusing on Rectal Cancer: A Meta-analysis
Robot-Assisted Versus Conventional Laparoscopic Surgery for Colorectal Disease, Focusing on Rectal Cancer: A Meta-analysis
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DOI：
10.1245/s10434-012-2429-9
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发表时间：
2012-11-01
影响因子：
3.7
通讯作者：
Ma, Yanlei
中科院分区：
文献类型：
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作者：
Yang, Yongzhi;Wang, Feng;Ma, Yanlei
机器人结直肠手术可能解决一些传统的腹腔镜手术(CLS)固有的问题。我们试图评估使用达芬奇手术系统的机器人辅助腹腔镜手术(RALS)在良性和恶性结直肠疾病患者中的优势。在PubMed和Embase数据库中搜索2011年7月之前发表的相关研究。选择了明确记录RALS和CLS在良性和恶性结直肠疾病中的比较的研究。评估手术和术后措施、切除范围、并发症和相关结果。采用随机效应模型计算加权平均差值、相对危险度和危险比。荟萃分析包括16项比较直肠疾病患者RALS和CLS的研究和7项直肠癌研究。与CLS相比，RALS在结直肠疾病(P=0.04)和直肠癌(P<；0.001)中的估计失血量较少，术中中转率在结直肠疾病(P=0.03)和直肠癌(P<；0.001)较低。然而，在大肠疾病患者中，RALS组的手术时间(P<；0.001)和总住院费用(P=0.06)高于CLS组，RALS组的估计失血量和术中中转率低于CLS组，但并发症发生率和手术成功的替代指标没有差异。机器人结直肠手术是一种很有前途的工具，特别是对于直肠癌患者。
Robotic colorectal surgery may solve some of the problems inherent to conventional laparoscopic surgery (CLS). We sought to evaluate the advantages of robot-assisted laparoscopic surgery (RALS) using the da Vinci Surgical System over CLS in patients with benign and malignant colorectal diseases.PubMed and Embase databases were searched for relevant studies published before July 2011. Studies clearly documenting a comparison of RALS with CLS for benign and malignant colorectal diseases were selected. Operative and postoperative measures, resection margins, complications, and related outcomes were evaluated. Weighted mean differences, relative risks, and hazard ratios were calculated using a random-effects model.The meta-analysis included 16 studies comparing RALS and CLS in patients with colorectal diseases and 7 studies in rectal cancer. RALS was associated with lower estimated blood loss in colorectal diseases (P = 0.04) and rectal cancer (P < 0.001) and lower rates of intraoperative conversion in colorectal diseases (P = 0.03) and rectal cancer (P < 0.001) than CLS. In patients with colorectal diseases, however, operating time (P < 0.001) and total hospitalization cost (P = 0.06) were higher for RALS than for CLS.RALS was associated with reduced estimated blood loss and a lower intraoperative conversion rate than CLS, with no differences in complication rates and surrogate markers of successful surgery. Robotic colorectal surgery is a promising tool, especially for patients with rectal cancer.