Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
Department of Pharmacy, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
Int J Colorectal Dis. 2019 Jun;34(6):983-991. doi: 10.1007/s00384-019-03307-0. Epub 2019 May 6.
TME has revolutionized the surgical management of rectal cancer, and since the introduction of robotic TME (RTME), many reports have shown the feasibility and the safety of this approach. However, concerns persist regarding the advantages of robotic in surgery for the completeness of TME. The aim of this review is to compare robotic versus laparoscopic total mesorectal excision (TME) in rectal cancer, focusing on the completeness of TME.
A systematic search was performed in the electronic databases for all available studies comparing RTME versus conventional laparoscopic LTME with declared grade of mesorectum excision. Data regarding sample size, clinical and demographic characteristics, number of complete, nearly complete, and incomplete TME were extracted. Primary outcome was the number of complete TME in robotic and laparoscopic procedures. Secondary outcomes were the numbers of nearly complete and incomplete TME in robotic and laparoscopic rectal resections.
Twelve articles were included in the final analysis. Complete TME was reported by all authors, involving 1510 procedures, showing a significant difference in favor of robotic surgery (OR = 1.83, 95% CI 1.08-3.10, p = 0.03). Nearly complete and incomplete TME showed no significant difference between the procedures. Meta-regression analysis showed that none of patients' and tumors' characteristics significantly impacted on complete TME.
Our results underline that the robotic approach to rectal resection is the better way to obtain a complete TME. However, it is mandatory that randomized clinical trials should be performed to assess definitively if robotic minimally invasive surgery is better than a laparoscopic resection.
全直肠系膜切除术（TME）彻底改变了直肠癌的外科治疗方式，自从机器人 TME（RTME）引入以来，许多报道已经证明了这种方法的可行性和安全性。然而，对于机器人在 TME 完整性方面的手术优势仍存在一些担忧。本综述的目的是比较机器人与腹腔镜全直肠系膜切除术（TME）在直肠癌中的应用，重点关注 TME 的完整性。
系统检索了电子数据库中所有比较 RTME 与传统腹腔镜 LTME 并声明直肠系膜切除程度的研究。提取样本量、临床和人口统计学特征、完全 TME、接近完全 TME 和不完全 TME 的数量等数据。主要结局是机器人和腹腔镜手术中完全 TME 的数量。次要结局是机器人和腹腔镜直肠切除术中接近完全和不完全 TME 的数量。
最终有 12 篇文章纳入了最终分析。所有作者均报告了完全 TME，共涉及 1510 例手术，机器人手术明显更有利于获得完全 TME（OR=1.83，95%CI 1.08-3.10，p=0.03）。接近完全和不完全 TME 两种手术之间没有显著差异。元回归分析显示，患者和肿瘤的特征均无显著影响完全 TME。
我们的结果强调，机器人直肠切除术是获得完全 TME 的更好方法。然而，必须进行随机临床试验来确定机器人微创手术是否优于腹腔镜切除术。
