General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy.
Department of Medical and Surgical Sciences, DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Surg Endosc. 2018 Mar;32(3):1104-1110. doi: 10.1007/s00464-017-5980-4. Epub 2017 Dec 7.
In the right colon surgery, there is a growing literature comparing the safety of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). With this paper we aim to systematically revise and meta-analyze the latest comparative studies on these two minimally invasive procedures.
A systematic review of studies published from 2000 to 2017 in the PubMed, Scopus, and Embase databases was performed. Primary endpoints were postoperative morbidity and mortality. Secondary endpoints were blood loss, conversion to open surgery, harvested lymph node anastomotic leak, postoperative hemorrhage, abdominal abscess, postoperative ileus, time to first flatus, non-surgical complications, wound infections, hospital stay, and incisional hernia and costs. A subgroup analysis was performed on those series presenting only extracorporeal anastomosis in both arms.
After screening 355 articles, 11 articles with a total of 8257 patients were eligible for inclusion. Operative time was found to be significantly shorter for the laparoscopic procedures in the pooled analysis (SMD - 0.99 95% CI - 1.4 to - 0.6, p < 0.001). Conversion to open surgery was more common during laparoscopic procedures than during the robotic ones (RR 1.7; 95% CI 1.1-2.6, p = 0.02). No significant differences in mortality (RR 0.47; 95% CI 0.18-1.23, p = 0.124) and postoperative complications (RR 1.05; 95% CI 0.9-1.2, p = 0.5) were found between LRC versus RRC. The pooled mean time to first flatus was higher in the laparoscopic group (SMD 0.85 days; 95% CI 0.16-1.54, p = 0.016). Hospital costs were significantly higher in RRCs (SMD - 0.52; 95% CI - 0.52 to - 0.04, p = 0.035).
RRC can be regarded as a feasible and safe technique. Its superiority in terms of postoperative recovery must be confirmed by further large prospective series comparing RRC and LRC performed with the same anastomotic technique. RRC seemed to be associated with higher costs than LRC.
在右半结肠手术中，越来越多的文献比较了机器人右结肠切除术（RRC）与腹腔镜右结肠切除术（LRC）的安全性。本文旨在系统地回顾和荟萃分析这两种微创方法的最新对照研究。
对 2000 年至 2017 年在 PubMed、Scopus 和 Embase 数据库中发表的研究进行了系统评价。主要终点是术后发病率和死亡率。次要终点是出血量、转为开放性手术、切除的淋巴结吻合口漏、术后出血、腹部脓肿、术后肠梗阻、首次排气时间、非手术并发症、伤口感染、住院时间、切口疝和费用。对两组均采用体外吻合术的系列进行了亚组分析。
经过筛选 355 篇文章，共有 11 篇文章的 8257 名患者符合纳入标准。荟萃分析发现腹腔镜手术的手术时间明显缩短（SMD-0.99，95%CI-1.4 至-0.6，p<0.001）。腹腔镜手术中转为开放性手术更为常见（RR1.7；95%CI1.1-2.6，p=0.02）。RRC 与 LRC 之间的死亡率（RR0.47；95%CI0.18-1.23，p=0.124）和术后并发症（RR1.05；95%CI0.9-1.2，p=0.5）无显著差异。首次排气时间的汇总平均值在腹腔镜组较高（SMD0.85 天；95%CI0.16-1.54，p=0.016）。RRC 的住院费用明显较高（SMD-0.52；95%CI-0.52 至-0.04，p=0.035）。
RRC 可视为一种可行且安全的技术。其在术后恢复方面的优势必须通过进一步的大型前瞻性系列研究来证实，这些研究应采用相同的吻合技术比较 RRC 和 LRC。RRC 似乎比 LRC 费用更高。
