Wang Xiaowei, Cao Gaoyang, Mao Weifang, Lao Weifeng, He Chao
Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
J Cancer Res Ther. 2020 Sep;16(5):979-989. doi: 10.4103/jcrt.JCRT_533_18.
This study aimed to compare clinical and oncological outcomes of robot-assisted and laparoscopic surgery for rectal cancer.
We searched PubMed/Medline, Embase, the Cochrane Library, Yahoo, and Google Scholar databases for relevant articles published up to 2017. Studies based on comparability between robot-assisted and laparoscopic surgery for rectal cancer were designated. Clinical outcomes included operative time, conversion to open surgery, estimated blood loss (EBL), bowel function recovery time, length of hospital stay (LOS), anastomosis leak, and postoperative complications. Oncological outcomes comprised the number of lymph nodes extracted, the positive circumferential margin (PCRM), and the distal resection margin (DRM).
Twenty studies were designated totaling 5496 patients, comprising a robot-assisted surgery patient group (n = 2168, 39.4%) and a laparoscopic surgery patient group (n = 3328, 60.6%). The robot-assisted surgery group was associated with longer operative time (odds ratio [OR] 0.48, 95% confidence interval [CI]; 0.14, 0.82), lower conversion to open surgery rate (OR 0.55, 95% CI; 0.44, 0.69), shorter LOS (OR - 0.15, 95% CI; -0.30, 0.00), faster bowel function recovery (OR - 0.38, 95% CI; -0.74, -0.02), and lower postoperative complications (OR 0.79, 95% CI; 0.65, 0.97). EBL, anastomosis leak rate, and oncological outcomes including the number of lymph nodes extracted, the DRM, and the PCRM showed no significant differences between groups.
Robot-assisted surgery for rectal cancer showed longer operative time, lower conversion, faster bowel function recovery rates, and shorter hospital stay, and similar oncological outcomes compared to laparoscopic surgery.
本研究旨在比较机器人辅助手术与腹腔镜手术治疗直肠癌的临床和肿瘤学结局。
我们检索了截至2017年发表的相关文章的PubMed/Medline、Embase、Cochrane图书馆、雅虎和谷歌学术数据库。纳入基于机器人辅助手术与腹腔镜手术治疗直肠癌的可比性的研究。临床结局包括手术时间、转为开放手术、估计失血量（EBL）、肠功能恢复时间、住院时间（LOS）、吻合口漏及术后并发症。肿瘤学结局包括提取的淋巴结数量、环周切缘阳性（PCRM）和远端切缘（DRM）。
共纳入20项研究，总计5496例患者，包括机器人辅助手术患者组（n = 2168，39.4%）和腹腔镜手术患者组（n = 3328，60.6%）。机器人辅助手术组的手术时间较长（优势比[OR] 0.48，95%置信区间[CI]；0.14，0.82），转为开放手术的发生率较低（OR 0.55，95% CI；0.44，0.69），住院时间较短（OR - 0.15，95% CI；-0.30，0.00），肠功能恢复较快（OR - 0.38，95% CI；-0.74，-0.02），术后并发症较少（OR 0.79，95% CI；0.65，0.97）。两组间EBL、吻合口漏发生率以及包括提取的淋巴结数量、DRM和PCRM在内的肿瘤学结局无显著差异。
与腹腔镜手术相比，机器人辅助直肠癌手术的手术时间较长，转为开放手术的发生率较低，肠功能恢复率较快，住院时间较短，且肿瘤学结局相似。
