Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
Surg Endosc. 2019 Nov;33(11):3558-3566. doi: 10.1007/s00464-019-07000-9. Epub 2019 Jul 25.
Robotic surgery (RS) may overcome the limitations of laparoscopic colorectal surgeries (LS) in obese patients, but remains less well studied. This systematic review and meta-analysis aims to evaluate the outcomes of obese patients who have undergone robotic colorectal surgery.
This study was performed according to the PRISMA guidelines. A search was performed on Medline, EMBASE, and the Cochrane Library to identify relevant articles. Dichotomous and continuous outcomes were analyzed as risk ratio (RR) and mean difference (MD), respectively. All post-operative outcomes were within 30 days after surgery. The quality of studies was assessed using the Newcastle-Ottawa Scale. Meta-regression analysis was conducted to identify sources of heterogeneity.
Three studies totaling 262 subjects compared LS (45.0%) against RS (55.0%) in obese patients. The RS group had a significantly reduced length of hospital stay (LOS) (MD - 2.55 days, 95%CI - 3.13 to - 1.97 days, P < 0.00001, I = 26%) and lower risk of re-admission (RR 0.42, 95%CI 0.19-0.92, P = 0.030, I = 0%), however, the length of operative time was longer (MD 40.54 min, 95%CI 32.72-48.36 min, P < 0.00001, I = 37%). Six studies totaling 761 subjects compared obese (40.5%) against non-obese (59.5%) patients who underwent RS. An increased operative time (MD 20.72 min, 95%CI 7.39-34.04 min, P = 0.002, I = 0%) and risk of wound infection (RR 2.59, 95%CI 1.12-6.02, P = 0.030, I = 0%) were noted in the former, with no differences in other intra- and post-operative outcomes. Meta-regression revealed that the pathology (rectal, colon, both) (P = 0.255), age (P = 0.530), gender (P = 0.279), and continent that the study originated from (P = 0.583) were not significant sources of heterogeneity for the risk of wound infection.
Compared to laparoscopy, robotic surgery provides earlier recovery with shorter LOS and reduced re-admission rates for obese patients, without compromising on other operative outcomes. Among patients undergoing robotic colorectal surgery, obesity is associated with a longer operative duration and greater risk of wound infection.
机器人手术 (RS) 可能克服肥胖患者腹腔镜结直肠手术 (LS) 的局限性，但研究仍较少。本系统评价和荟萃分析旨在评估肥胖患者接受机器人结直肠手术后的结果。
本研究按照 PRISMA 指南进行。在 Medline、EMBASE 和 Cochrane 图书馆进行检索，以确定相关文章。二分类和连续结果分别以风险比 (RR) 和均数差 (MD) 进行分析。所有术后结果均在手术后 30 天内。使用纽卡斯尔-渥太华量表评估研究质量。进行荟萃回归分析以确定异质性的来源。
三项研究共纳入 262 例肥胖患者，比较 LS（45.0%）与 RS（55.0%）。RS 组的住院时间（LOS）明显缩短（MD -2.55 天，95%CI -3.13 至 -1.97 天，P < 0.00001，I = 26%），再入院风险降低（RR 0.42，95%CI 0.19-0.92，P = 0.030，I = 0%），但手术时间较长（MD 40.54 分钟，95%CI 32.72-48.36 分钟，P < 0.00001，I = 37%）。六项研究共纳入 761 例肥胖（40.5%）和非肥胖（59.5%）患者接受 RS。前者手术时间较长（MD 20.72 分钟，95%CI 7.39-34.04 分钟，P = 0.002，I = 0%）和伤口感染风险增加（RR 2.59，95%CI 1.12-6.02，P = 0.030，I = 0%），但其他围手术期结果无差异。荟萃回归显示，病理学（直肠、结肠、两者）（P = 0.255）、年龄（P = 0.530）、性别（P = 0.279）和研究来源的大陆（P = 0.583）不是伤口感染风险的显著异质性来源。
与腹腔镜相比，机器人手术为肥胖患者提供了更早的恢复，LOS 更短，再入院率更低，而其他手术结果不受影响。在接受机器人结直肠手术的患者中，肥胖与手术时间延长和伤口感染风险增加有关。
