Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, PR China; Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, PR China.
Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, PR China.
Asian J Surg. 2020 Sep;43(9):880-890. doi: 10.1016/j.asjsur.2019.11.003. Epub 2020 Jan 18.
Although several meta-analyses regarding robot-assisted proctectomy (RP) and laparoscopic proctectomy (LP) in patients with rectal cancer are constantly being published, meta-analyses considering randomized controlled trials (RCTs) are still rare. It is therefore necessary to conduct an appropriate meta-analysis to provide reliable evidence for clinical decision-making. Databases such as PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials (CCTR) and Cochrane Database of Systematic Reviews (CDSR) were used to collect RCTs assessing the effectiveness and safety of RP and LP. Article search was performed until August 2019. Data were extracted and the quality was evaluated by two reviewers independently, according to the inclusion and exclusion criteria. Data were analyzed using R software. Eight RCTs were included involving 999 patients, 495 of them underwent RP and 504 underwent LP. The results showed that the RP group had a longer operative time (P < 0.01), a lower conversion rate (P = 0.03), a longer distance to the distal margin (DDM) (P = 0.001), and a lower incidence of erectile dysfunction (P = 0.02). No significant differences were found in perioperative mortality, complication rates, PRM, number of harvested lymph nodes, length of hospital stay and time to first bowel movement between the two groups. Current evidence suggests that RP is superior to LP in short-term clinical outcomes, which is similar to LP regarding pathological outcomes and has better DDM outcomes. However, the comparison between RP and LP regarding long-term oncology outcomes still require further multi-center and large RCT samples to confirm our evidences.
尽管不断有关于机器人辅助直肠切除术(RP)和腹腔镜直肠切除术(LP)治疗直肠癌的荟萃分析发表,但考虑到随机对照试验(RCT)的荟萃分析仍然很少。因此,有必要进行适当的荟萃分析,为临床决策提供可靠的证据。我们使用 PubMed、EMBASE、Web of Science、Cochrane 对照试验注册中心(CCTR)和 Cochrane 系统评价数据库(CDSR)等数据库收集了评估 RP 和 LP 有效性和安全性的 RCT。文献检索截至 2019 年 8 月。根据纳入和排除标准,由两名评审员独立提取数据并评估质量。使用 R 软件分析数据。纳入了 8 项 RCT,共涉及 999 例患者,其中 495 例行 RP,504 例行 LP。结果显示,RP 组手术时间更长(P<0.01),中转率更低(P=0.03),远端切缘距离(DDM)更短(P=0.001),勃起功能障碍发生率更低(P=0.02)。两组患者围手术期死亡率、并发症发生率、保肛率、淋巴结清扫数目、住院时间和首次排便时间无显著差异。目前的证据表明,RP 在短期临床结局方面优于 LP,在病理结局方面与 LP 相似,DDM 结局更好。然而,RP 与 LP 之间的长期肿瘤学结局比较仍需要进一步的多中心和大样本 RCT 来证实我们的证据。
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