Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
Surg Endosc. 2019 Apr;33(4):1033-1048. doi: 10.1007/s00464-018-06648-z. Epub 2019 Feb 4.
To evaluate short- and long-term outcomes of robotic gastrectomy (RG) in patients with gastric cancer to determine whether RG is an acceptable alternative to laparoscopic gastrectomy (LG).
PubMed, Embase, the Cochrane Library, and Chinese Biomedical Database were searched for prospective observational studies (POSs) comparing RG with LG for gastric cancer until October 2017. We compared short-term and long-term outcomes using systematic review with meta-analysis and trial sequential analysis (TSA).
Sixteen POSs including 4576 patients were included in the meta-analyses. Compared with LG, RG had longer operative time (MD 57.98 min, P < 0.00001), lesser blood loss (MD - 23.71 ml, P = 0.005), and shorter time to first post-operative flatulence (MD - 0.14 days, P = 0.03). No significant difference was found in terms of the number of harvested lymph nodes, complications, reoperation, mortality, open conversion, proximal resection margin, and distal resection margin. The meta-analyses of complications, overall survival, and disease-free survival did not yield any sign of statistically significant difference between the two treatments, and the cumulative Z-curve crossed neither the traditional boundary nor the trial sequential monitoring boundary, suggesting the lack of firm evidence. TSA demonstrated that the cumulative Z-curve crossed either the traditional boundary or the trial sequential monitoring boundary on blood loss and operative time.
The present study demonstrates that RG is as acceptable as LG in terms of short- and long-term outcomes. The TSA demonstrated that further studies are not needed to evaluate the operative time and blood loss differences between these techniques.
评估机器人胃切除术（RG）治疗胃癌的短期和长期结果，以确定 RG 是否可作为腹腔镜胃切除术（LG）的替代方法。
检索了PubMed、Embase、Cochrane 图书馆和中国生物医学文献数据库中截至 2017 年 10 月比较 RG 与 LG 治疗胃癌的前瞻性观察性研究（POS）。我们使用系统评价和荟萃分析以及试验序贯分析（TSA）比较了短期和长期结果。
纳入了 16 项 POS 研究，共 4576 例患者。与 LG 相比，RG 手术时间更长（MD 57.98 分钟，P < 0.00001），出血量更少（MD -23.71 毫升，P = 0.005），首次术后肛门排气时间更短（MD -0.14 天，P = 0.03）。两组间淋巴结清扫数目、并发症、再次手术、死亡率、中转开腹、近端切缘和远端切缘无显著差异。并发症、总生存和无病生存的荟萃分析未发现两种治疗方法之间存在统计学显著差异的迹象，累积 Z 曲线既未穿过传统边界，也未穿过试验序贯监测边界，提示缺乏确凿证据。TSA 显示，在出血量和手术时间方面，累积 Z 曲线穿过了传统边界或试验序贯监测边界。
本研究表明，RG 在短期和长期结果方面与 LG 一样可接受。TSA 表明，不需要进一步研究来评估这两种技术之间的手术时间和出血量差异。
