Jones Katie, Qassem Mohamed G, Sains Parv, Baig Mirza K, Sajid Muhammad S
Department of General and Laparoscopic Colorectal Surgery, Brighton and Sussex University Hospitals NHS Trust, the Royal Sussex County Hospital, Brighton, West Sussex BN2 5BE, United Kingdom.
Department of General and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, West Sussex BN11 2DH, United Kingdom.
World J Gastrointest Oncol. 2018 Nov 15;10(11):449-464. doi: 10.4251/wjgo.v10.i11.449.
To compare outcomes in patients undergoing rectal resection by robotic total meso-rectal excision (RTME) laparoscopic total meso-rectal excision (LTME).
Standard medical electronic databases such as PubMed, MEDLINE, EMBASE and Scopus were searched to find relevant articles. The data retrieved from all types of included published comparative trials in patients undergoing RTME LTME was analysed using the principles of meta-analysis. The operative, post-operative and oncological outcomes were evaluated to assess the effectiveness of both techniques of TME. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR).
One RCT (ROLARR trial) and 27 other comparative studies reporting the non-oncological and oncological outcomes following RTME LTME were included in this review. In the random effects model analysis using the statistical software Review Manager 5.3, the RTME was associated with longer operation time (SMD, 0.46; 95%CI: 0.25, 0.67; z = 4.33; = 0.0001), early passage of first flatus ( = 0.002), lower risk of conversion ( = 0.00001) and shorter hospitalization ( = 0.01). The statistical equivalence was seen between RTME and LTME for non-oncological variables like blood loss, morbidity, mortality and re-operation risk. The oncological variables such as recurrence ( = 0.96), number of harvested nodes ( = 0.49) and positive circumferential resection margin risk ( = 0.53) were also comparable in both groups. The length of distal resection margins was similar in both groups.
RTME is feasible and oncologically safe but failed to demonstrate any superiority over LTME for many surgical outcomes except early passage of flatus, lower risk of conversion and shorter hospitalization.
比较接受机器人全直肠系膜切除术（RTME）与腹腔镜全直肠系膜切除术（LTME）的患者的手术结果。
检索标准医学电子数据库，如PubMed、MEDLINE、EMBASE和Scopus，以查找相关文章。使用荟萃分析原则分析从所有纳入的已发表的RTME与LTME患者比较试验中检索到的数据。评估手术、术后和肿瘤学结果，以评估两种全直肠系膜切除术技术的有效性。连续变量的汇总结果表示为标准化均数差（SMD），二分数据以比值比（OR）呈现。
本综述纳入了一项随机对照试验（ROLARR试验）和其他27项比较研究，报告了RTME与LTME后的非肿瘤学和肿瘤学结果。在使用统计软件Review Manager 5.3进行的随机效应模型分析中，RTME与更长的手术时间相关（SMD，0.46；95%CI：0.25，0.67；z = 4.33；P = 0.0001）、首次排气更早（P = 0.002）、更低的中转风险（P = 0.00001）和更短的住院时间（P = 0.01）。对于失血、发病率、死亡率和再次手术风险等非肿瘤学变量，RTME和LTME之间存在统计学等效性。两组的肿瘤学变量，如复发（P = 0.96）、收获淋巴结数量（P = 0.49）和环周切缘阳性风险（P = 0.53）也具有可比性。两组远端切缘长度相似。
RTME是可行的，且在肿瘤学上是安全的，但除了排气更早、中转风险更低和住院时间更短外，在许多手术结果方面未能证明优于LTME。
