Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis
Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis
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DOI：
10.1016/j.jss.2014.01.027
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发表时间：
2014-05-01
影响因子：
2.2
通讯作者：
Cheng, Yong
中科院分区：
文献类型：
--
作者：
Xiong, Binghong;Ma, Li;Cheng, Yong
背景资料：机器人手术已成功应用于许多外科分支，但在文献中很少有证据表明其用于直肠癌（RC）。我们进行了这项荟萃分析，包括随机对照试验和非随机对照试验的机器人全直肠系膜切除术（RTME）与腹腔镜全直肠系膜切除术（LTME），以评估是否与RC患者的安全性和有效性RTME等同于LTME.Materials和Methods：Pubmed，Embase，科克伦图书馆，奥维德，和Web的科学数据库进行了搜索。选择了明确记录RC的RTME与LTME比较的研究。手术和恢复的结果，术后早期发病率，和肿瘤学参数进行了evaluated.Results：8项研究确定，包括1229例患者，554（45.08%）在RTME和675（54.92%）在LTME。Meta分析显示，RTME中转开放手术率显著低于LTME（P = 0.0004）。两组在手术时间、估计失血量、恢复结局、术后发病率和死亡率、住院时间以及肿瘤切除准确性和局部复发方面无显著差异。结论：RTME治疗RC安全可行，中短期肿瘤学和功能结局与LTME相当或优于LTME。它可能是RC的替代治疗方法。需要更多的多中心随机对照试验研究长期肿瘤和功能结局，以确定RTME在RC中优于LTME。(C)2014爱思唯尔公司All rights reserved.
Background: Robotic surgery has been used successfully in many branches of surgery; but there is little evidence in the literature on its use in rectal cancer (RC). We conducted this meta-analysis that included randomized controlled trials and nonrandomized controlled trials of robotic total mesorectal excision (RTME) versus laparoscopic total mesorectal excision (LTME) to evaluate whether the safety and efficacy of RTME in patients with RC are equivalent to those of LTME.Materials and methods: Pubmed, Embase, Cochrane Library, Ovid, and Web of Science databases were searched. Studies clearly documenting a comparison of RTME with LTME for RC were selected. Operative and recovery outcomes, early postoperative morbidity, and oncological parameters were evaluated.Results: Eight studies were identified that included 1229 patients in total, 554 (45.08%) in the RTME and 675 (54.92%) in the LTME. Meta-analysis suggested that the conversion rate to open surgery in RTME was significantly lower than in LTME (P = 0.0004). There were no significant differences in operation time, estimated blood loss, recovery outcome, postoperative morbidity and mortality, length of hospital stay, and the oncological accuracy of resection and local recurrence between the two groups. The positive rate of circumferential resection margins (P = 0.04) and the incidence of erectile dysfunction (P = 0.002) were lower in RTME compared with LTME.Conclusions: RTME for RC is safe and feasible, and the short-and medium-term oncological and functional outcomes are equivalent or preferable to LTME. It may be an alternative treatment for RC. More multicenter randomized controlled trials investigating the long-term oncological and functional outcomes are required to determine the advantages of RTME over LTME in RC. (C) 2014 Elsevier Inc. All rights reserved.