Hu Li-Dong, Li Xiao-Fei, Wang Xiu-Yue, Guo Tian-Kang
Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Yinchuan, China E-mail :
Asian Pac J Cancer Prev. 2016;17(9):4327-4333.
To systematically review efficacyand safety of robotic gastrectomy (RG) compared with conventional laparoscopic gastrectomy (LG) for gastric carcinoma.
A systematic literature search was carried out using PubMed, Cochrane Library, CBM, CNKI, WanFang, VIP and other sources like relevant references to obtain comparative studies assessing the effectiveness and safety between RG and LG published between 2013 and 2016. Then the literature was screened and the data were extracted by 2 independent reviewers. The quality of the literature was assessed, and the data analyzed using Stata/SE 14 software. Fixed effects or random effects models wereapplied according to heterogeneity.
A total of 12 non-randomized observational clinical studies involving 3,580 patients were included, of which 1,096 had undergone RG and 2,484 had received LG. The results of the meta-analysis showed in terms of effectiveness, RG was associated with less blood loss, less time to first flatus and greater number of harvested lymph nodes, but there were no significant differences in proximal and distal resection margins, compared with LG. In terms of efficiency, RG was associated with shorter hospital stay, but longer operative time. In terms of safety, there were no statistically significant differences in complications, mortality and conversions between RG and LG.
RG can achieve comparable or better short-term and radical effects than LG, with respect to effectiveness, efficiency and safety in treatment of gastric carcinoma. Future studies involving RG should focus on decreasing operative time and reducing cost. Moreover, there is a need for randomized controlled trials comparing the two techniques with long-term follow-up.
系统评价机器人胃癌切除术（RG）与传统腹腔镜胃癌切除术（LG）相比的疗效和安全性。
通过PubMed、Cochrane图书馆、中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方、维普等数据库以及相关参考文献进行系统文献检索，以获取2013年至2016年发表的评估RG与LG有效性和安全性的比较研究。然后由2名独立审阅者对文献进行筛选并提取数据。评估文献质量，并使用Stata/SE 14软件进行数据分析。根据异质性采用固定效应或随机效应模型。
共纳入12项非随机观察性临床研究，涉及3580例患者，其中1096例行RG，2484例行LG。荟萃分析结果显示，在有效性方面，RG与更少的失血量、更短的首次排气时间以及更多的清扫淋巴结数量相关，但与LG相比，近端和远端切缘无显著差异。在效率方面，RG与更短的住院时间相关，但手术时间更长。在安全性方面，RG与LG在并发症、死亡率和中转率方面无统计学显著差异。
在治疗胃癌的有效性、效率和安全性方面，RG可取得与LG相当或更好的短期和根治效果。未来涉及RG的研究应侧重于缩短手术时间和降低成本。此外，需要进行随机对照试验比较这两种技术并进行长期随访。
