Department of Surgery, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
Asian J Surg. 2019 Jun;42(6):657-666. doi: 10.1016/j.asjsur.2018.11.007. Epub 2019 Jan 2.
Controversy still surrounds clinical benefits of robotic-assisted (RS) over laparoscopic surgery (LS) despite its popularity in clinical use in terms of outcomes and complication rates. The study aims to systematically review and provide the evidence concerning the risk of conversion to open laparotomy and oncological outcomes of LS vs RS rectal cancer surgery. The Cochrane Library (including the Cochrane Central Register of Controlled Trials), EMBASE, PubMed, SCOPUS, and Web of Science were searched for randomized controlled trials (RCTs) comparing LS and RS. Eight RCTs including 1305 patients were identified. Pooled conversion rate was reported in 49 (11.89%) of 412 patients who underwent LS and in 23 (5.72%) of 402 patients who underwent RS (95% CI, 1.357 to 3.613; P = .001). However, shorter operative time was noted in LS group than RS group (95% CI, -43.106 to -3.876; P = .019). No significant difference in other outcomes was observed. Finally, in further analysis, the mean age in trial-level was found to be positively associated with operative time (point estimate = 2.598; 95% CI, 1.584 to 3.612; P < .001) and negatively with length of hospital stay. Robot-assisted surgery in rectal cancer showed lower conversion rate in comparison with that of laparoscopic surgery. Secondly, the laparoscopic surgery has shorter operative time compared with robot-assisted approach. The results also showed similar pathological outcomes between these two modalities. Future studies are needed to clarify the relationship between mean age and outcomes of surgery.
尽管机器人辅助手术（RS）在临床应用中因其结果和并发症发生率而广受欢迎，但在临床获益方面仍存在争议。本研究旨在系统地回顾和提供有关 LS 与 RS 直肠肿瘤手术之间中转开腹风险和肿瘤学结果的证据。Cochrane 图书馆（包括 Cochrane 对照试验中心注册库）、EMBASE、PubMed、SCOPUS 和 Web of Science 均被用于搜索比较 LS 和 RS 的随机对照试验（RCT）。确定了 8 项 RCT，共纳入 1305 例患者。有 412 例行 LS 手术的患者中报告了 49 例（11.89%）的中转率，402 例行 RS 手术的患者中报告了 23 例（5.72%）（95% CI，1.357 至 3.613；P =.001）。然而，LS 组的手术时间明显短于 RS 组（95% CI，-43.106 至-3.876；P =.019）。其他结果无显著差异。最后，在进一步分析中，发现试验水平的平均年龄与手术时间呈正相关（点估计=2.598；95% CI，1.584 至 3.612；P<.001），与住院时间呈负相关。与腹腔镜手术相比，机器人辅助手术在直肠癌中具有较低的中转率。其次，腹腔镜手术的手术时间比机器人辅助手术短。结果还表明，这两种方式的病理结果相似。需要进一步的研究来阐明手术平均年龄与手术结果之间的关系。
