腹腔镜与机器人直肠癌手术及对中转率的影响：一项随机对照试验和倾向评分匹配研究的荟萃分析。
Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies.
机构信息
Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Sydney, NSW, Australia.
The University of Sydney, Westmead Clinical School, Sydney, NSW, Australia.
出版信息
Tech Coloproctol. 2019 Mar;23(3):221-230. doi: 10.1007/s10151-018-1920-0. Epub 2019 Jan 8.
BACKGROUND
The usage of robotic surgery in rectal cancer is increasing, but there is an ongoing debate as to whether it provides any benefit. The aim of the present study was to determine if robotic surgery results in less conversion to an open operation than laparoscopic rectal cancer surgery.
METHODS
A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club and Database of Abstracts of Review of Effectiveness. Included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies comparing a robotic vs. laparoscopic approach to rectal cancer surgery. The primary endpoint was conversion to open. All statistical analyses and data synthesis were conducted using STATA/IC version 14·2, Windows 64 bit (StataCorp LP, College Station, TX, USA) RESULTS: Six hundred and twenty-one studies were identified through electronic database search. After application of selection criteria as per PRISMA and MOOSE criteria, six RCTs and five PSM articles were analyzed. From the six RCTs, 512 robotic and 519 laparoscopic cases were evaluated. There was a significantly lower rate of conversion for the robotic surgery arm (4.1% vs. 8.1%, OR 0.28; 95% CI 0.00-0.57). Of the five PSM studies, 2097 robotic and 3053 laparoscopic cases were evaluated. There was a significantly lower conversion to open rate found in the robotic surgery cohort (7.4% vs. 15.6%; OR 0.39; 95% CI 0.30-0.47). Pooled RCT and PSM data demonstrated significantly lower conversion rates for robotic surgery (6.7% vs. 14.5%; OR 0.38; 95% CI 0.30-0.46).
CONCLUSIONS
Robotic surgery for rectal cancer is associated with reduced conversion to open surgery compared to a laparoscopic approach.
背景
机器人手术在直肠癌中的应用正在增加，但对于它是否能带来益处仍存在争议。本研究旨在确定机器人手术是否比腹腔镜直肠癌手术导致更少的中转开腹手术。
方法
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，使用 Ovid Medline、PubMed、Cochrane 对照试验中心注册库、Cochrane 系统评价数据库、ACP 期刊俱乐部和疗效评价文摘数据库进行荟萃分析。纳入了比较机器人与腹腔镜直肠癌手术的随机对照试验（RCT）和倾向评分匹配（PSM）研究。主要终点是中转开腹手术。所有统计分析和数据综合均使用 STATA/IC 版本 14.2、Windows 64 位（StataCorp LP，德克萨斯州学院站）进行。
结果
通过电子数据库搜索共确定了 621 项研究。根据 PRISMA 和 MOOSE 标准应用选择标准后，分析了 6 项 RCT 和 5 项 PSM 文章。从 6 项 RCT 中，评估了 512 例机器人手术和 519 例腹腔镜手术。机器人手术组的中转开腹率明显较低（4.1%比 8.1%，OR 0.28；95%CI 0.00-0.57）。在 5 项 PSM 研究中，评估了 2097 例机器人手术和 3053 例腹腔镜手术。机器人手术组中转开腹率明显较低（7.4%比 15.6%，OR 0.39；95%CI 0.30-0.47）。汇总的 RCT 和 PSM 数据表明，机器人手术的中转开腹率明显较低（6.7%比 14.5%，OR 0.38；95%CI 0.30-0.46）。
结论
与腹腔镜手术相比，机器人手术治疗直肠癌可降低中转开腹手术的发生率。
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