Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, People's Republic of China; Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China.
Institution of Clinical Research and Evidence Based Medicine, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China.
Asian J Surg. 2018 Sep;41(5):401-416. doi: 10.1016/j.asjsur.2017.07.001. Epub 2017 Sep 12.
This meta-analysis aimed to investigate the effectiveness and safety of RAH and LLR for liver neoplasms. A systematic search was performed in PubMed, EMbase, the Cochrane Library, Web of science, and China Biology Medicine disc up to July 2016 for studies that provided comparisons between the surgical outcomes of RAH and LLR for liver neoplasms. WMD, OR and 95% CI were calculated and data combined using the random-effect model. The quality of the evidence was assessed using GRADE methods. A total of 17 studies were included in the meta-analysis, in which 487 patients were in the RAH group and 902 patients were in the LLR group. The meta-analysis results indicated: compared to LLR, RAH was associated with more estimated blood loss, longer operative time, and longer time to first nutritional intake (p < 0.05). There was no significant difference in length of hospital stay, conversion rate during operation, R0 resection rate, complications and mortality (p > 0.05). Three studies reported the total cost, and the result showed a higher cost in the RAH group when compared with the LLR group (p < 0.05). This meta-analysis indicated that RAH and LLR display similar effectiveness and safety in hepatectomy. Considering the lack of high quality original studies, prospective clinical trials should be conducted to provide strong evidence for clinical guidelines formation, and the insurance coverage policies should be established to promote the application of robotic surgery in the future.
本荟萃分析旨在探讨 RAH 和 LLR 治疗肝脏肿瘤的有效性和安全性。系统检索了 PubMed、EMbase、Cochrane 图书馆、Web of Science 和中国生物医学文献数据库,检索时限均截止至 2016 年 7 月,以获取比较 RAH 和 LLR 治疗肝脏肿瘤手术结果的研究。使用随机效应模型计算 WMD、OR 和 95%CI 并进行数据合并。使用 GRADE 方法评估证据质量。共有 17 项研究纳入荟萃分析,其中 487 例患者接受 RAH 治疗,902 例患者接受 LLR 治疗。荟萃分析结果表明:与 LLR 相比,RAH 术中出血量更多,手术时间更长,首次营养摄入时间更长(p<0.05)。两组患者的住院时间、术中中转率、R0 切除率、并发症发生率和死亡率无显著差异(p>0.05)。有 3 项研究报道了总费用,结果显示 RAH 组的总费用高于 LLR 组(p<0.05)。本荟萃分析表明,RAH 和 LLR 在肝切除术中具有相似的有效性和安全性。考虑到高质量原始研究的缺乏,应开展前瞻性临床试验,为临床指南的制定提供有力证据,并制定保险覆盖政策,以促进机器人手术在未来的应用。
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