Caruso Stefano, Patriti Alberto, Roviello Franco, De Franco Lorenzo, Franceschini Franco, Ceccarelli Graziano, Coratti Andrea
Stefano Caruso, Franco Franceschini, Department of General Surgery and Surgical Specialties, Unit of General Surgery, "Santa Maria Annunziata" Hospital, Local Health Unit Center Tuscany Company, 50012 Florence, Italy.
World J Clin Oncol. 2017 Jun 10;8(3):273-284. doi: 10.5306/wjco.v8.i3.273.
To evaluate the potential effectiveness of robot-assisted gastrectomy (RAG) in comparison to open gastrectomy (OG) for gastric cancer patients.
A comprehensive systematic literature search using PubMed, EMBASE, and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer. Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy. A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, morbidity, and hospital stay. Secondary among postoperative complications, wound infection, bleeding and anastomotic leakage were also analysed.
A total of 6 articles, 5 retrospective and 1 randomized controlled study, involving 6123 patients overall, with 689 (11.3%) cases submitted to RAG and 5434 (88.7%) to OG, satisfied the eligibility criteria and were included in the meta-analysis. RAG was associated with longer operation time than OG (weighted mean difference 72.20 min; < 0.001), but with reduction in blood loss and shorter hospital stay (weighted mean difference -166.83 mL and -1.97 d respectively; < 0.001). No differences were found with respect to overall postoperative complications ( = 0.65), wound infection ( = 0.35), bleeding ( = 0.65), and anastomotic leakage ( = 0.06). The postoperative mortality rates were similar between the two groups. With respect to oncological outcomes, no statistical differences among the number of harvested lymph nodes were found (weighted mean difference -1.12; = 0.10).
RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.
评估机器人辅助胃癌切除术（RAG）相较于开腹胃癌切除术（OG）对胃癌患者的潜在有效性。
利用PubMed、EMBASE和Cochrane图书馆进行全面的系统文献检索，以识别比较RAG和OG治疗胃癌的研究。在两项技术的比较研究中，纳入任何年龄和性别的参与者，且独立于胃切除术类型。进行短期围手术期结果的荟萃分析，以评估RAG是否等同于OG。主要结局指标设定为估计失血量、手术时间、转化率、发病率和住院时间。还分析了术后并发症、伤口感染、出血和吻合口漏等次要指标。
共有6篇文章，5篇回顾性研究和1篇随机对照研究，总共涉及6123例患者，其中689例（11.3%）接受RAG，5434例（88.7%）接受OG，满足纳入标准并被纳入荟萃分析。RAG与比OG更长的手术时间相关（加权平均差72.20分钟；<0.001），但失血量减少且住院时间缩短（加权平均差分别为-166.83 mL和-1.97天；<0.001）。在总体术后并发症（=0.65）、伤口感染（=0.35）、出血（=0.65）和吻合口漏（=0.06）方面未发现差异。两组术后死亡率相似。关于肿瘤学结局，在获取的淋巴结数量上未发现统计学差异（加权平均差-1.12；=0.10）。
对于胃癌根治性胃切除术，RAG似乎是OG在技术上有效的替代方法，且并发症安全。
