Li X M, Wang J
Department of Gynecology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 Mar 25;52(3):175-183. doi: 10.3760/cma.j.issn.0529-567X.2017.03.007.
To evaluate the safety and effectiveness of robotic surgery in surgical staging of endometrial cancer. Searched English and Chinese databases, including Cochrane library, PubMed, Embase, Web of Science, China National Knowledge Internet, data base of Wanfang, China Science and Technology Journal (CSTJ) , and relevant journals and magazines by hand from Jan. 2000 to Oct. 2016. (1) In accordance with the inclusion criteria, two independent investigators screened databases and extracted the relevant data respectively, then evaluated the quality of including studies in Newcastle-Ottawa Scale (NOS) . (2) Meta-analysis was performed with RevMan 5.3 software. Heterogeneity inspection was done for each study and different effect model included the random effect model and fixed effect model was chose according to the of the inspection. At last, the related parameters of the robotic surgery and laparoscopic surgery was analysed. Results (1) Thirteen articles were ultimately included. All of them were written in English and included a total of 1 554 patients, included 739 cases of robotic surgery and 815 cases of laparoscopic surgery. Thirteen articles were all cohort study, four of them were prospective cohort study, while others were retrospective cohort study. After quality assessment, all studies had more than 5 stars and illustrated the higher quality. (2) Meta-analysis results showed: compared with laparoscopic surgery in surgical staging of endometrial cancer, robotic surgery had less estimated blood loss [standard deviation ()=-72.31 ml, 95%:-107.29 to-37.33, <0.01], less time for hospital stay (=-0.29 days, 95%:-0.46 to-0.13, =0.001), less need for blood transfusion [risk ratio ()=0.57, 95%: 0.33 to 0.97, =0.040], and conversion to open surgery (=0.41, 95%: 0.26 to 0.65, =0.000), less intraoperative complications (=0.43, 95%: 0.24 to 0.76, =0.004) in surgical staging of endometrial cancer. There was no statistically significant difference in aspects of operative time (=10.26 minutes, 95% :-13.62 to 34.13, =0.400), postoperative complications (=0.87, 95% : 0.67 to 1.12, =0.280), the total number of lymph nodes removed (=-0.04, 95% :-3.99 to 3.91, =0.980), the number of pelvic lymph node dissection (=0.48, 95%:-1.76 to 2.71, =0.680) and the number of para-aortic lymph node dissection (=0.46, 95%:-1.42 to 2.34, =0.630). Compared the robotic surgery with laparoscopic surgery in surgical staging of endometrial cancer, robotic surgery has less estimated blood loss, less need for blood transfusion and conversion to open surgery, less intraoperative complications and other advantages. While its cost is so expensive that restrict clinical application.
评估机器人手术在子宫内膜癌手术分期中的安全性和有效性。检索了英文和中文数据库，包括考克兰图书馆、PubMed、Embase、科学引文索引、中国知网、万方数据库、中国科技期刊数据库，并通过手工检索2000年1月至2016年10月的相关期刊和杂志。（1）按照纳入标准，由两名独立研究者分别筛选数据库并提取相关数据，然后采用纽卡斯尔-渥太华量表（NOS）评估纳入研究的质量。（2）使用RevMan 5.3软件进行Meta分析。对每项研究进行异质性检验，并根据检验结果选择随机效应模型和固定效应模型这两种不同的效应模型。最后，分析机器人手术和腹腔镜手术的相关参数。结果（1）最终纳入13篇文章。所有文章均为英文撰写，共纳入1554例患者，其中机器人手术739例，腹腔镜手术815例。13篇文章均为队列研究，其中4篇为前瞻性队列研究，其余为回顾性队列研究。经过质量评估，所有研究均获得5颗星以上，表明质量较高。（2）Meta分析结果显示：在子宫内膜癌手术分期中，与腹腔镜手术相比，机器人手术估计失血量更少[标准差（SD）=-72.31ml，95%可信区间：-107.29至-37.33，P<0.01]，住院时间更短（MD=-0.29天，95%可信区间：-0.46至-0.13，P=0.001），输血需求更少[风险比（RR）=0.57，95%可信区间：0.33至0.97，P=0.040]，中转开腹手术比例更低（RR=0.41，95%可信区间：0.26至0.65，P=0.000），术中并发症更少（RR=0.43，95%可信区间：0.24至0.76，P=0.004）。在手术时间（MD=10.26分钟，95%可信区间：-13.62至34.13，P=0.400）、术后并发症（RR=0.87，95%可信区间：0.67至1.12，P=0.280）、切除淋巴结总数（MD=-0.04，95%可信区间：-3.99至3.91，P=0.980）、盆腔淋巴结清扫数（RR=0.48，95%可信区间：-1.76至2.71，P=0.680）和腹主动脉旁淋巴结清扫数（RR=0.46，95%可信区间：-1.42至2.34，P=0.630）方面，差异无统计学意义。与腹腔镜手术相比，机器人手术在子宫内膜癌手术分期中具有估计失血量更少、输血需求和中转开腹手术比例更低、术中并发症更少等优势。但其成本过高，限制了临床应用。
