Wang Yi, Zhao Xudong, Song Yanjing, Cai Aizhen, Xi Hongqing, Chen Lin
Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.
Medicine (Baltimore). 2017 Dec;96(48):e8797. doi: 10.1097/MD.0000000000008797.
Robotic-assisted gastrectomy (RAG) has been used for gastric cancer since 2002. This meta-analysis was carried out to evaluate whether RAG is safer and more effective than conventional laparoscopically assisted gastrectomy (LAG) for gastric cancer.
We performed a manual search for these 2 types of operations (RAG and LAG) in the PubMed, Embase, and the Cochrane Library databases up to April 30, 2016. Twelve nonrandomized controlled trials that reported on RAG and LAG for gastric cancer were included. Outcomes evaluated included operation time, number of retrieved lymph nodes, blood loss, length of the resection margin, complications, and postoperative hospital stay.
A total of 3744 patients in 12 studies were included (1134 patients in the RAG group and 2610 patients in the LAG group). The operation time was significantly shorter in the LAG group [weighted mean difference (WMD) 42.0 (95% confidence interval, 95% CI 28.11-55.89) minutes; P < .00001], while the loss of blood volume was lower in the RAG group (P = .01). The number of retrieved lymph nodes, duration of postoperative stay, length of the proximal resection margin, length of the distal resection margin, and postoperative complications were similar between groups.
We conclude that RAG is a safe and appropriate treatment for gastric cancer patients in comparison to LAG. Nevertheless, RAG is not superior to LAG. Future research on RAG should focus on comparing the differences in retrieved lymph nodes in different tiers, evaluating the postoperative recovery and reducing the cost of the treatment.
自2002年以来，机器人辅助胃癌切除术（RAG）已应用于胃癌治疗。本荟萃分析旨在评估RAG在治疗胃癌方面是否比传统腹腔镜辅助胃癌切除术（LAG）更安全、更有效。
我们在PubMed、Embase和Cochrane图书馆数据库中手动检索了截至2016年4月30日的这两种手术（RAG和LAG）的相关文献。纳入了12项关于RAG和LAG治疗胃癌的非随机对照试验。评估的结果包括手术时间、清扫淋巴结数量、失血量、切缘长度、并发症及术后住院时间。
12项研究共纳入3744例患者（RAG组1134例，LAG组2610例）。LAG组手术时间显著更短[加权平均差（WMD）42.0（95%置信区间，95%CI 28.11 - 55.89）分钟；P <.00001]，而RAG组失血量更低（P = 0.01）。两组间清扫淋巴结数量、术后住院时长、近端切缘长度、远端切缘长度及术后并发症相似。
我们得出结论，与LAG相比，RAG是胃癌患者的一种安全且合适的治疗方法。然而，RAG并不优于LAG。未来关于RAG的研究应聚焦于比较不同层次清扫淋巴结的差异、评估术后恢复情况及降低治疗成本。
