The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Jieshou Hospital of Traditional Chinese Medicine, China.
The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.
Asian J Surg. 2021 Apr;44(4):615-628. doi: 10.1016/j.asjsur.2020.12.016. Epub 2021 Jan 16.
The aim of this study was to compare the clinical safety and efficacy of robotic hepatectomy (RH) versus conventional laparoscopic hepatectomy (LH) for malignancy using meta-analysis. A systematic literature search was performed using PubMed, EMBASE, Medline and the Cochrane Library databases up to September 2020 for studies, which limited to comparative articles of RH or LH for malignant tumors. Stata14.0 was performed in the meta-analysis. Six studies with a total of 1093 patients (345 RH and 748 LH) were eligible for inclusion. Operative time, tumor size, open procedure rate and the proportion of right hepatectomy were found to be significantly different between RH and LH in the pooled analysis (P < 0.05). Compared to LH, RH was associated with longer operative time, larger tumor size, lower open procedure rate and more common use for right hepatectomy. On the other hand, there was no difference in the operative time, estimated blood loss (EBL), blood transfusion rate, hospital stay, R0 resection rate, complications, resection margin, left lateral sectionectomy and left hepatectomy (P > 0.05). For malignant tumors that require hepatectomy, robotic approaches have demonstrated similar safety and feasibility to laparoscopy, with lower open procedure rate, were suitable for larger tumor size, and have a high right hepatectomy utilization rate. These results still need to be confirmed by multicenter, high-quality randomized controlled studies.
本研究旨在通过荟萃分析比较机器人肝切除术（RH）与传统腹腔镜肝切除术（LH）治疗恶性肿瘤的临床安全性和疗效。系统检索了 PubMed、EMBASE、Medline 和 Cochrane 图书馆数据库，截至 2020 年 9 月，仅纳入比较 RH 或 LH 治疗恶性肿瘤的研究。使用 Stata14.0 进行荟萃分析。共有 6 项研究，共 1093 例患者（345 例 RH 和 748 例 LH）符合纳入标准。荟萃分析发现，RH 和 LH 之间的手术时间、肿瘤大小、开腹手术率和右半肝切除术比例存在显著差异（P<0.05）。与 LH 相比，RH 手术时间更长，肿瘤更大，开腹手术率更低，更常用于右半肝切除术。另一方面，两组的手术时间、估计出血量（EBL）、输血率、住院时间、R0 切除率、并发症、切缘、左外叶切除术和左半肝切除术差异无统计学意义（P>0.05）。对于需要肝切除术的恶性肿瘤，机器人方法与腹腔镜相比具有相似的安全性和可行性，开腹手术率更低，适用于更大的肿瘤大小，并且具有较高的右半肝切除术利用率。这些结果仍需要多中心、高质量的随机对照研究来证实。
