Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Paolo Giaccone University Hospital, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Unit of General and Oncological Surgery, Paolo Giaccone University Hospital, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
Langenbecks Arch Surg. 2021 Aug;406(5):1317-1339. doi: 10.1007/s00423-020-01985-x. Epub 2020 Sep 9.
The aim of the present systematic review and meta-analysis is to compare laparoscopic right colectomy (LRC) versus robotic right colectomy (RRC) using homogeneous subgroup analyses for extra-corporeal anastomosis (EA) and intra-corporeal anastomosis (IA).
MEDLINE, Scopus, and Web of Science databases were searched up to April 2020 for prospective or retrospective studies comparing LRC versus RRC on at least one short- or long-term outcome. The primary outcome was the length of hospital stay (LOS). The secondary outcomes included operative and pathological results, survival, and total costs. LRC and RRC were compared using three homogeneous subgroups: without distinction by the type of anastomosis, EA only, and IA only. Pooled data analyses were performed using mean difference (MD) and random effects model.
Thirty-seven of 448 studies were selected. The included patients were 21,397 for the LRC group and 2796 for the RRC group. Regardless for the type of anastomosis, RRC showed shorter LOS, lower blood loss, lower conversion rate, shorter time to flatus, and lower overall complication rate compared with LRC, but longer operative time and higher total costs. In the EA subgroup, RRC showed similar LOS, longer operative time, and higher costs compared with LRC, the other outcomes being similar. In the IA subgroup, RRC showed shorter LOS and longer operative time compared with LRC, with no difference for the remaining outcomes.
Most included articles are retrospective, providing low-quality evidence and limiting conclusions. The more frequent use of the IA seems to explain the advantages of RRC over LRC.
本系统评价和荟萃分析的目的是通过对体外吻合（EA）和体内吻合（IA）的同质亚组分析，比较腹腔镜右半结肠切除术（LRC）与机器人右半结肠切除术（RRC）。
检索 MEDLINE、Scopus 和 Web of Science 数据库，截至 2020 年 4 月，查找比较至少一项短期或长期结果的 LRC 与 RRC 的前瞻性或回顾性研究。主要结果是住院时间（LOS）。次要结果包括手术和病理结果、生存和总费用。使用无吻合类型区别、仅 EA 和仅 IA 的三个同质亚组比较 LRC 和 RRC。使用均数差（MD）和随机效应模型进行汇总数据分析。
从 448 项研究中筛选出 37 项。纳入的患者中，LRC 组为 21397 例，RRC 组为 2796 例。无论吻合类型如何，RRC 组的 LOS 更短、出血量更少、转化率更低、排气时间更早、总并发症发生率更低，但手术时间更长、总费用更高。在 EA 亚组中，RRC 组的 LOS 与 LRC 相似，手术时间更长，成本更高，其他结果相似。在 IA 亚组中，RRC 组的 LOS 比 LRC 短，手术时间更长，但其余结果无差异。
大多数纳入的文章为回顾性研究，提供的证据质量较低，限制了结论的得出。更频繁地使用 IA 似乎可以解释 RRC 优于 LRC 的原因。
