Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China; Jiangxi Medical College of Nanchang University, Nanchang University Health Science Center, Nanchang, 330006, Jiangxi Province, China.
Department of Anesthesiology, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China.
Int J Surg. 2020 Aug;80:225-230. doi: 10.1016/j.ijsu.2020.03.009. Epub 2020 Apr 3.
BACKGROUND: Short-term outcomes of robotic mesorectal excision for rectal cancer resection seem comparable to those of conventional laparoscopic mesorectal excision. However, the long-term oncological outcomes of robot mesorectal excision require further investigation. MATERIALS AND METHODS: The PubMed, EMBASE, Medline, and Cochrane Library databases were searched from the date of database inception to March 31, 2019 for all available trials; the results of robotic and laparoscopic mesorectal excision for rectal cancer surgery were compared. Survival parameters, including overall survival (OS) and disease-free survival (DFS), were independently extracted by two investigators. Hazard ratios (HRs) were calculated using random- or fixed-effects models. The presence of heterogeneity was assessed using Q test, and the extent of heterogeneity was quantified by I index. The meta-analysis was performed using Review Manager software, version 5.3. RESULTS: A total of seven studies including 2593 patients (1362 treated by robotic mesorectal excision and 1231 by laparoscopic mesorectal excision) were included. Pooled analyses showed no significant difference in OS (HR = 0.94, 95% confidence interval [CI]: 0.63 to 1.39, P = 0.75) or DFS (HR = 0.93, 95% CI: 0.79 to 1.10, P = 0.85) between the robotic and laparoscopic mesorectal excision for treatment of rectal cancer. CONCLUSION: Regarding long-term survival, robotic mesorectal excision for rectal cancer is comparable to laparoscopic mesorectal excision. More prospective, multicenter randomized trials with longer follow-up periods are needed to determine the long-term outcomes of patients undergoing robotic mesorectal excision.
背景:机器人直肠系膜切除术治疗直肠癌的短期疗效似乎与传统腹腔镜直肠系膜切除术相当。然而,机器人直肠系膜切除术的长期肿瘤学结果仍需进一步研究。
材料与方法:从数据库建立日期到 2019 年 3 月 31 日,我们检索了 PubMed、EMBASE、Medline 和 Cochrane Library 数据库,以获取所有可用的试验;比较了机器人和腹腔镜直肠系膜切除术治疗直肠癌的结果。两名研究者独立提取生存参数,包括总生存(OS)和无病生存(DFS)。使用随机或固定效应模型计算风险比(HR)。使用 Q 检验评估异质性的存在,并使用 I 指数量化异质性的程度。使用 Review Manager 软件,版本 5.3 进行荟萃分析。
结果:共纳入 7 项研究,包括 2593 例患者(1362 例接受机器人直肠系膜切除术,1231 例接受腹腔镜直肠系膜切除术)。汇总分析显示,OS(HR=0.94,95%置信区间:0.63 至 1.39,P=0.75)或 DFS(HR=0.93,95%置信区间:0.79 至 1.10,P=0.85)方面,机器人直肠系膜切除术与腹腔镜直肠系膜切除术治疗直肠癌无显著差异。
结论:就长期生存而言,机器人直肠系膜切除术治疗直肠癌与腹腔镜直肠系膜切除术相当。需要更多前瞻性、多中心、随机临床试验,并进行更长时间的随访,以确定接受机器人直肠系膜切除术的患者的长期结局。
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