Int J Surg. 2020 Oct;82:210-228. doi: 10.1016/j.ijsu.2020.07.053. Epub 2020 Aug 12.
Minimally invasive surgery (MIS) has been increasingly used in the treatment of gastric cancer (GC). Laparoscopic gastrectomy (LG) has shown several advantages over open surgery in dealing with GC, although it is still considered a demanding procedure. Robotic gastrectomy (RG) is now being employed with increased frequency worldwide and has been reported to overcome some limitations of conventional LG. The aim of this updated meta-analysis is to compare surgical and oncological outcomes of RG versus LG for gastric cancer.
A systematic review and meta-analysis was conducted using the PubMed, MEDLINE and Cochrane library database of published studies comparing RG and LG up to March 2020. The evaluated end-points were intra-operative, post-operative and oncological outcomes. Dichotomous data were calculated by odds ratio (OR) and continuous data were calculated by mean difference (MD) with 95% confidence intervals (95% CI), and a random-effect model was always applied.
Forty retrospective studies describing 17,712 patients met the inclusion criteria. With respect to surgical outcomes, robotic compared with laparoscopic gastrectomy was associated with higher operating time [MD 44.73, (95%CI 36.01, 53.45) p < 0.00001] and less intraoperative blood loss [MD -18.24, (95%CI -25.21, -11.26) p < 0.00001] and lower rate of surgical complication in terms of Dindo-Clavien ≥ 3 classification [OR 0.66, (95%CI 0.49, 0.88) p = 0.005]. With respect to oncological outcomes, the RG group showed a significantly increased mean number of retrieved lymph nodes [MD 1.84, (95%CI 0.84, 2.84) p = 0.0003], but mean proximal and distal resection margin distance and the recurrence rate were not significantly different between the two approaches.
With respect to safety, technical feasibility and oncological adequacy, robotic and laparoscopic groups were comparable, although the robotic approach seems to achieve better short-term surgical outcomes. Moreover, a higher rate of retrieved lymph nodes was observed in the RG group.
微创外科（MIS）已越来越多地用于治疗胃癌（GC）。与开放性手术相比，腹腔镜胃切除术（LG）在治疗 GC 方面具有许多优势，尽管它仍被认为是一种要求较高的手术。机器人胃切除术（RG）目前在全球范围内的应用越来越频繁，并且已经被报道可以克服传统 LG 的一些局限性。本更新的荟萃分析旨在比较 RG 与 LG 治疗胃癌的手术和肿瘤学结果。
使用 PubMed、MEDLINE 和 Cochrane 图书馆数据库对截至 2020 年 3 月发表的比较 RG 和 LG 的研究进行了系统回顾和荟萃分析。评估的终点是术中、术后和肿瘤学结果。二项数据通过比值比（OR）计算，连续数据通过均数差（MD）和 95%置信区间（95%CI）计算，并且总是应用随机效应模型。
有 40 项回顾性研究描述了 17712 名符合纳入标准的患者。就手术结果而言，与腹腔镜胃切除术相比，机器人胃切除术的手术时间更长[MD 44.73，（95%CI 36.01，53.45）p<0.00001]，术中出血量更少[MD-18.24，（95%CI-25.21，-11.26）p<0.00001]，且根据 Dindo-Clavien≥3 分级，手术并发症发生率更低[OR 0.66，（95%CI 0.49，0.88）p=0.005]。就肿瘤学结果而言，RG 组显示出明显增加的平均淋巴结检出数[MD 1.84，（95%CI 0.84，2.84）p=0.0003]，但近端和远端切除边缘距离以及复发率在两种方法之间没有显著差异。
就安全性、技术可行性和肿瘤学充分性而言，机器人组和腹腔镜组相当，尽管机器人方法似乎能获得更好的短期手术结果。此外，RG 组的淋巴结检出率较高。
