Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
Int J Med Robot. 2021 Dec;17(6):e2329. doi: 10.1002/rcs.2329. Epub 2021 Sep 9.
Improving survival rates in rectal cancer patients has generated a growing interest in functional outcomes after total mesorectal excision (TME). The well-established low anterior resection syndrome (LARS) score assesses postoperative anorectal impairment after TME. Our meta-analysis is the first to compare bowel function after open, laparoscopic, transanal, and robotic TME.
All studies reporting functional outcomes after rectal cancer surgery (LARS score) were included, and were compared with a consecutive series of robotic TME (n = 48).
Thirty-two publications were identified, including 5 565 patients. Anorectal function recovered significantly better within one year after robotic TME (3.8 [95%CI -9.709-17.309]) versus laparoscopic TME (26.4 [95%CI 19.524-33.286]), p = 0.006), open TME (26.0 [95%CI 24.338-29.702], p = 0.002) and transanal TME (27.9 [95%CI 22.127-33.669], p = 0.003).
Robotic TME enables better recovery of anorectal function compared to other techniques. Further prospective, high-quality studies are needed to confirm the benefits of robotic surgery.
提高直肠癌患者的生存率使得人们对全直肠系膜切除（TME）后的功能结果产生了越来越大的兴趣。经过充分验证的低位前切除综合征（LARS）评分评估了 TME 后的肛门直肠损伤。我们的荟萃分析是第一个比较开放、腹腔镜、经肛和机器人 TME 后肠功能的分析。
纳入所有报告直肠癌手术后功能结果（LARS 评分）的研究，并与一系列连续的机器人 TME 进行比较（n=48）。
确定了 32 篇文献，包括 5565 名患者。与腹腔镜 TME（26.4[95%CI 19.524-33.286]）相比，机器人 TME 后一年内肛门直肠功能恢复明显更好（3.8[95%CI-9.709-17.309]），p=0.006）、开放 TME（26.0[95%CI 24.338-29.702]，p=0.002）和经肛 TME（27.9[95%CI 22.127-33.669]，p=0.003）。
与其他技术相比，机器人 TME 能更好地恢复肛门直肠功能。需要进一步前瞻性、高质量的研究来证实机器人手术的益处。
