机器人与腹腔镜直肠癌手术后的泌尿生殖功能：荟萃分析。

Urogenital function following robotic and laparoscopic rectal cancer surgery: meta-analysis.

机构信息

Department of Colorectal Surgery, Cork University Hospital, Cork, Ireland.

Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland.

出版信息

Br J Surg. 2021 Mar 12;108(2):128-137. doi: 10.1093/bjs/znaa067.

DOI:10.1093/bjs/znaa067

PMID:33711141

Abstract

BACKGROUND

Mixed results are reported on clinical and cancer outcomes in laparoscopic rectal cancer surgery (LRCS) compared with robotic rectal cancer surgery (RRCS). However, more favourable functional outcomes are reported following RRCS. This study compared urinary and sexual function following RRCS and LRCS in male and female patients.

METHODS

A systematic review and meta-analysis of urinary and sexual function after RRCS and LRCS was performed following PRISMA and MOOSE guidelines, and registered prospectively with PROSPERO (ID:CRD42020164285). The functional outcome reporting tools most commonly included: the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI). Mean scores and changes in mean scores from baseline were analysed using RevMan version 5.3.

RESULTS

Ten studies were included reporting on 1286 patients. Some 672 patients underwent LRCS, of whom 380 (56.5 per cent) were men and 116 (17.3 per cent) were women (gender not specified in 176 patients, 26.2 per cent). A total of 614 patients underwent RRCS, of whom 356 (58.0 per cent) were men and 83 (13.5 per cent) were women (gender not specified in 175 patients, 28.5 per cent). Regarding urinary function in men at 6 months after surgery, IPSS scores were significantly better in the RRCS group than in the LRCS group (mean difference (MD) -1.36, 95 per cent c.i. -2.31 to -0.40; P = 0.005), a trend that persisted at 12 months (MD -1.08, -1.85 to -0.30; P = 0.007). ΔIIEF scores significantly favoured RRCS at 6 months [MD -3.11 (95%CI -5.77, -0.44) P <0.021] and 12 months [MD -2.76 (95%CI -3.63, -1.88) P <0.001] post-operatively. Mixed urinary and sexual function outcomes were reported for women.

CONCLUSION

This meta-analysis identified more favourable urinary and erectile function in men who undergo robotic compared with conventional laparoscopic surgery for rectal cancer. Outcomes in women did not identify a consistently more favourable outcome in either group. As robotic rectal cancer surgery may offer more favourable functional outcomes it should be considered and discussed with patients.

摘要

背景

与机器人直肠切除术（RRCS）相比，腹腔镜直肠切除术（LRCS）在临床和癌症结果方面的报告结果存在差异。然而，RRCS 后报告的功能结果更理想。本研究比较了男性和女性患者接受 RRCS 和 LRCS 后的尿功能和性功能。

方法

根据 PRISMA 和 MOOSE 指南对 RRCS 和 LRCS 后的尿功能和性功能进行系统评价和荟萃分析，并在 PROSPERO（ID：CRD42020164285）上进行前瞻性登记。最常包括的功能结果报告工具是：国际前列腺症状评分（IPSS）、国际勃起功能指数（IIEF）和女性性功能指数（FSFI）。使用 RevMan 版本 5.3 分析基线时的平均评分和平均评分变化。

结果

纳入了 10 项研究，共报告了 1286 名患者。其中 672 名患者接受了 LRCS 治疗，其中 380 名（56.5%）为男性，116 名（17.3%）为女性（176 名患者未指定性别，占 26.2%）。614 名患者接受了 RRCS 治疗，其中 356 名（58.0%）为男性，83 名（13.5%）为女性（175 名患者未指定性别，占 28.5%）。在术后 6 个月时，男性的尿功能方面，RRCS 组的 IPSS 评分明显优于 LRCS 组（MD-1.36，95%CI-2.31 至-0.40；P=0.005），这一趋势在 12 个月时仍然存在（MD-1.08，-1.85 至-0.30；P=0.007）。术后 6 个月[MD-3.11（95%CI-5.77，-0.44）P<0.021]和 12 个月[MD-2.76（95%CI-3.63，-1.88）P<0.001]时，RRCS 组的 ΔIIEF 评分显著更优。对于女性，报告了混合的尿功能和性功能结果。