Division of General Surgery, Department of Biomedical Sciences of Health, IRCCS Policlinico San Donato, University of Milan Medical School, San Donato Milanese, Milan, Italy.
Department of Surgery, Connolly Hospital, Blanchardstown, Dublin, Ireland.
Surg Endosc. 2019 Apr;33(4):1020-1032. doi: 10.1007/s00464-018-6592-3. Epub 2018 Nov 19.
There are a variety of surgical approaches for the management of right-sided colonic neoplasms. To date, no method has been shown superior in terms of surgical and perioperative outcomes. This meta-analysis compared open (ORH), laparoscopic-assisted (LRH), total laparoscopic (TLRH), and robotic right hemicolectomy (RRH) to assess surgical outcomes and perioperative morbidity and mortality.
We conducted an electronic systematic search using PubMed, EMBASE, and Web of Science that compared RRH, TLRH, LRH, and ORH. Forty-eight studies met the inclusion criteria: 5 randomized controlled trials, 25 retrospective, and 18 prospective studies totalling 5652 patients were included.
The overall complication rate was similar between RRH and TLRH (RR 1.0; Crl 0.66-1.5). The anastomotic leak rate was higher in LRH and ORH compared to RRH (RR 1.9; Crl 0.99-3.6 and RR 1.2; Crl 0.55-2.6, respectively), whereas it was lower in TLRH compared to RRH (RR 0.88 Crl 0.41-1.9). The risk of reoperation was significantly higher in ORH compared to TLRH (RR 3.3; Crl 1.3-8.0). Operative time was similar in RRH compared to LRH (RR - 27.0; Crl - 61.0 to 5.9), and to TLRH (RR - 24.0; Crl - 70.0 to 21.0). The hospital stay was significantly longer in LRH compared to RRH (RR 3.7; Crl 0.7-6.7).
The surgical management of right-sided colonic disease is evolving. This network meta-analysis observed that short-term outcomes following RRH and TLRH were superior to standard LRH and ORH. The adoption of more advanced minimally invasive techniques can be costly and have associated learning phases, but will ultimately improve patient outcomes.
右侧结肠肿瘤的治疗有多种手术方法。迄今为止，尚无一种方法在手术和围手术期结果方面显示出优越性。本荟萃分析比较了开腹（ORH）、腹腔镜辅助（LRH）、全腹腔镜（TLRH）和机器人右半结肠切除术（RRH），以评估手术结果和围手术期发病率和死亡率。
我们使用 PubMed、EMBASE 和 Web of Science 进行了电子系统检索，比较了 RRH、TLRH、LRH 和 ORH。符合纳入标准的 48 项研究：5 项随机对照试验、25 项回顾性研究和 18 项前瞻性研究，共纳入 5652 例患者。
RRH 和 TLRH 的总体并发症发生率相似（RR 1.0；Crl 0.66-1.5）。LRH 和 ORH 的吻合口漏发生率高于 RRH（RR 1.9；Crl 0.99-3.6 和 RR 1.2；Crl 0.55-2.6），而 TLRH 则低于 RRH（RR 0.88 Crl 0.41-1.9）。ORH 的再次手术风险明显高于 TLRH（RR 3.3；Crl 1.3-8.0）。RRH 的手术时间与 LRH 相似（RR -27.0；Crl -61.0 至 5.9），与 TLRH 相似（RR -24.0；Crl -70.0 至 21.0）。LRH 的住院时间明显长于 RRH（RR 3.7；Crl 0.7-6.7）。
右侧结肠疾病的手术治疗正在不断发展。本网络荟萃分析观察到，RRH 和 TLRH 后的短期结果优于标准 LRH 和 ORH。采用更先进的微创技术可能成本高昂且具有相关的学习阶段，但最终将改善患者的预后。
