Department of Colorectal Surgery, Ealing Hospital, North West London Hospitals NHS Trust, London, UK.
Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
Int J Colorectal Dis. 2020 Aug;35(8):1423-1438. doi: 10.1007/s00384-020-03655-2. Epub 2020 Jun 19.
We aimed to evaluate comparative outcomes of robotic and laparoscopic total mesorectal excision (TME) in patients with rectal cancer.
We systematically searched electronic data sources with application of combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators, and limits. Perioperative clinical and short-term oncological outcomes were evaluated. Trial Sequential Analysis of the outcomes was conducted.
Nine randomised-controlled trials reporting 1463 patients evaluating outcomes of robotic TME (n = 728) and laparoscopic TME (n = 735) were included. Although the robotic approach was associated with significantly longer operative time (MD 31.64, P = 0.002), it was associated with significantly longer DRM (MD 0.8, P = 0.004) and shorter time to soft diet (MD - 0.50, P = 0.03) compared to the laparoscopic approach. Moreover, there was no significant difference in intraoperative (RR 1.07, P = 0.76)) and postoperative (RR 0.97, P = 0.81) complications, anastomotic leak (RR 0.93, P = 0.69), conversion to open rate (RR 0.46, P = 0.05), blood loss (MD 19.65, P = 0.74), time to first flatus (MD - 0.30, P = 0.37), LARS (RR 0.83, P = 0.41), ileus (RR 0.72, P = 0.39), positive CRM (RR 0.82, P = 0.49), PRM (MD - 0.5, P = 0.55), number of harvested lymph nodes (MD 0.33, P = 0.58), or length of stay (MD - 0.60, P = 0.12) between two groups. The Trial Sequential Analysis demonstrated that the risk of type 1 and type 2 errors was minimal in most outcomes.
Moderate-quality evidence suggested that robotic and laparoscopic TME may be comparable in terms of clinical and short-term oncological profile but the robotic approach may be associated with longer procedure time. Future high-quality randomised studies are encouraged to compare the functional, long-term oncological, and cost-effectiveness outcomes of both approaches.
我们旨在评估机器人辅助与腹腔镜辅助全直肠系膜切除术（TME）治疗直肠癌患者的疗效。
我们系统地检索了电子数据库，并应用了适合词库标题、搜索运算符和限制的自由文本和受控词汇搜索组合。评估了围手术期临床和短期肿瘤学结果。对结果进行了试验序贯分析。
纳入了 9 项随机对照试验，共报告了 1463 例患者，评估了机器人 TME（n = 728）和腹腔镜 TME（n = 735）的疗效。尽管机器人手术的手术时间明显更长（MD 31.64，P = 0.002），但它与明显更长的直肠系膜游离距离（MD 0.8，P = 0.004）和更短的软食时间（MD - 0.50，P = 0.03）相关。此外，机器人手术与腹腔镜手术相比，术中（RR 1.07，P = 0.76）和术后（RR 0.97，P = 0.81）并发症、吻合口漏（RR 0.93，P = 0.69）、中转开腹率（RR 0.46，P = 0.05）、出血量（MD 19.65，P = 0.74）、首次排气时间（MD - 0.30，P = 0.37）、LARS 评分（RR 0.83，P = 0.41）、肠梗阻（RR 0.72，P = 0.39）、CRM 阳性（RR 0.82，P = 0.49）、PRM（MD - 0.5，P = 0.55）、清扫淋巴结数目（MD 0.33，P = 0.58）和住院时间（MD - 0.60，P = 0.12）无显著差异。试验序贯分析表明，大多数结局的Ⅰ型和Ⅱ型错误风险较低。
中质量证据表明，机器人辅助与腹腔镜辅助 TME 在临床和短期肿瘤学特征方面可能相似，但机器人辅助手术可能与手术时间较长有关。鼓励未来进行高质量的随机研究，以比较两种方法的功能、长期肿瘤学和成本效益结果。
