Gavriilidis P, Wheeler J, Spinelli A, de'Angelis N, Simopoulos C, Di Saverio S
Division of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
Colorectal Surgery Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
Colorectal Dis. 2020 Nov;22(11):1506-1517. doi: 10.1111/codi.15084. Epub 2020 May 15.
The debate about the oncological adequacy, safety and efficiency of robotic vs laparoscopic total mesorectal excision for rectal cancers continues. Therefore, an updated, traditional and cumulative meta-analysis was performed with the aim of assessing the new evidence on this topic.
A systematic search of the literature for data pertaining to the last 25 years was performed. Fixed- and random-effects models were used to cumulatively assess the accumulation of evidence over time.
Patients with a significantly higher body mass index (BMI), tumours located approximately 1 cm further distally and more patients undergoing neoadjuvant therapy were included in the robotic total mesorectal excision (RTME) cohort compared with those in the laparoscopic total mesorectal excision (LTME) cohort [RTME, mean difference (MD) = 0.22 (0.07, 0.36), P = 0.005; LTME, MD = -0.97 (-1.57, 0.36), P < 0.002; OR = 1.47 (1.11, 1.93), P = 0.006]. Significantly lower conversion rates to open surgery were observed in the RTME cohort than in the LTME cohort [OR = 0.33 (0.24, 0.46), P < 0.001]. Operative time in the LTME cohort was significantly reduced (by 50 min) compared with the RTME cohort. Subgroup analysis of the three randomized controlled trials (RCTs) challenged all the significant results of the main analysis and demonstrated nonsignificant differences between the RTME cohort and LTME cohort.
Although the RTME cohort included patients with a significantly higher BMI, more distal tumours and more patients undergoing neoadjuvant therapy, this cohort demonstrated lower conversion rates to open surgery when compared with the LTME cohort. However, subgroup analysis of the RCTs demonstrated nonsignificant differences between the two procedures.
关于机器人辅助与腹腔镜全直肠系膜切除术治疗直肠癌的肿瘤学充分性、安全性和有效性的争论仍在继续。因此，进行了一项更新的、传统的累积荟萃分析，旨在评估该主题的新证据。
对过去25年的相关文献进行系统检索。采用固定效应模型和随机效应模型对证据随时间的积累进行累积评估。
与腹腔镜全直肠系膜切除术（LTME）队列相比，机器人辅助全直肠系膜切除术（RTME）队列纳入的患者体重指数（BMI）显著更高，肿瘤位置距肛缘约远1 cm，接受新辅助治疗的患者更多[RTME，平均差（MD）=0.22（0.07，0.36），P = 0.005；LTME，MD = -0.97（-1.57，0.36），P < 0.002；OR = 1.47（1.11，1.93），P = 0.006]。与LTME队列相比，RTME队列中转开腹手术率显著更低[OR = 0.33（0.24，0.46），P < 0.001]。与RTME队列相比，LTME队列的手术时间显著缩短（50分钟）。三项随机对照试验（RCT）的亚组分析对主要分析的所有显著结果提出了挑战，并显示RTME队列和LTME队列之间无显著差异。
尽管RTME队列纳入的患者BMI显著更高、肿瘤位置更低且接受新辅助治疗的患者更多，但与LTME队列相比，该队列中转开腹手术率更低。然而，RCT的亚组分析显示两种手术之间无显著差异。
