Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Department of Urology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany.
Surg Endosc. 2021 Jan;35(1):81-95. doi: 10.1007/s00464-019-07361-1. Epub 2020 Feb 5.
Surgical resection is crucial for curative treatment of rectal cancer. Through multidisciplinary treatment, including radiochemotherapy and total mesorectal excision, survival has improved substantially. Consequently, more patients have to deal with side effects of treatment. The most recently introduced surgical technique is robotic-assisted surgery (RAS) which seems equally effective in terms of oncological control compared to laparoscopy. However, RAS enables further advantages which maximize the precision of surgery, thus providing better functional outcomes such as sexual function or contience without compromising oncological results. This review was done according to the PRISMA and AMSTAR-II guidelines and registered with PROSPERO (CRD42018104519). The search was planned with PICO criteria and conducted on Medline, Web of Science and CENTRAL. All screening steps were performed by two independent reviewers. Inclusion criteria were original, comparative studies for laparoscopy vs. RAS for rectal cancer and reporting of functional outcomes. Quality was assessed with the Newcastle-Ottawa scale. The search retrieved 9703 hits, of which 51 studies with 24,319 patients were included. There was a lower rate of urinary retention (non-RCTs: Odds ratio (OR) [95% Confidence Interval (CI)] 0.65 [0.46, 0.92]; RCTs: OR[CI] 1.29[0.08, 21.47]), ileus (non-RCTs: OR[CI] 0.86[0.75, 0.98]; RCTs: OR[CI] 0.80[0.33, 1.93]), less urinary symptoms (non-RCTs mean difference (MD) [CI] - 0.60 [- 1.17, - 0.03]; RCTs: - 1.37 [- 4.18, 1.44]), and higher quality of life for RAS (only non-RCTs: MD[CI]: 2.99 [2.02, 3.95]). No significant differences were found for sexual function (non-RCTs: standardized MD[CI]: 0.46[- 0.13, 1.04]; RCTs: SMD[CI]: 0.09[- 0.14, 0.31]). The current meta-analysis suggests potential benefits for RAS over laparoscopy in terms of functional outcomes after rectal cancer resection. The current evidence is limited due to non-randomized controlled trials and reporting of functional outcomes as secondary endpoints.
手术切除是治疗直肠癌的关键。通过多学科治疗，包括放化疗和全直肠系膜切除术，生存率得到了显著提高。因此，更多的患者需要应对治疗的副作用。最近引入的手术技术是机器人辅助手术（RAS），它在肿瘤控制方面与腹腔镜手术同样有效。然而，RAS 还具有进一步的优势，可以最大限度地提高手术精度，从而提供更好的功能结果，如性功能或控便能力，而不会影响肿瘤学结果。这项综述是根据 PRISMA 和 AMSTAR-II 指南进行的，并在 PROSPERO（CRD42018104519）上进行了注册。搜索是根据 PICO 标准计划的，并在 Medline、Web of Science 和 CENTRAL 上进行。所有的筛选步骤都是由两名独立的评审员进行的。纳入标准是原始的、比较性的研究，比较腹腔镜与 RAS 治疗直肠癌的功能结果。质量评估采用纽卡斯尔-渥太华量表。搜索共检索到 9703 条记录，其中 51 项研究共纳入 24319 例患者。RAS 的尿潴留发生率较低（非 RCT：优势比（OR）[95%置信区间（CI）] 0.65 [0.46, 0.92]；RCT：OR[CI] 1.29[0.08, 21.47]），肠梗阻发生率较低（非 RCT：OR[CI] 0.86[0.75, 0.98]；RCT：OR[CI] 0.80[0.33, 1.93]），尿症状较轻（非 RCT：均数差值（MD）[CI] -0.60 [-1.17, -0.03]；RCT：-1.37 [-4.18, 1.44]），生活质量更高（仅非 RCT：MD[CI]：2.99 [2.02, 3.95]）。RAS 在性功能方面没有显著差异（非 RCT：标准化 MD[CI]：0.46[-0.13, 1.04]；RCT：SMD[CI]：0.09[-0.14, 0.31]）。目前的荟萃分析表明，RAS 在直肠癌切除术后的功能结果方面可能优于腹腔镜手术。由于非随机对照试验和作为次要终点报告的功能结果，目前的证据有限。
