Tang Qin, Liu Weichu, Jiang Dan, Tang Junying, Zhou Qin, Zhang Jing
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610000 Sichuan, China.
J Oncol. 2022 Apr 30;2022:2084774. doi: 10.1155/2022/2084774. eCollection 2022.
We aimed to compare the perioperative and survival outcomes of robotic-assisted surgery, traditional laparoscopy, and laparotomy approaches in ovarian cancer.
PubMed, Cochrane Library, Embase, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) were searched using multiple terms for ovarian cancer surgeries, including comparative studies in Chinese and English. Literatures are published before August 31, 2021. The outcomes include operating time, estimated blood loss, length of hospital stay, postoperative/intraoperative/total complications, pelvic/para-aortic/total lymph nodes, transfusion, and five-year overall survival rate. The dichotomous data, continuous data, and OS data were pooled and reported as relative risk, standardized mean differences, and hazard ratio HRs with 95% confidence intervals, respectively. The Newcastle-Ottawa Scale was used to evaluate the risk of bias of included studies.
Thirty-eight studies, including 8,367 patients and three different surgical approaches (robotic-assisted laparoscopy surgery, traditional laparoscopy, or laparotomy approaches), were included in this network meta-analysis. Our analysis shows that the operating time of laparotomy was shorter than laparoscopy. The robotic-assisted laparoscopy has the least estimated blood loss during the surgery, followed by laparoscopy, and finally laparotomy. Compared with laparotomy, the incidence of blood transfusion was lower in the robotic-assisted laparoscopy and laparoscopy groups, and the length of hospital stay is shorter. Laparotomy had a significantly higher incidence of total complications than robotic-assisted laparoscopy and laparoscopy and higher postoperative complications than laparoscopy. For the number of pelvic/para-aortic/total lymph nodes removed by different surgical approaches, our analysis revealed no statistical difference. Our analysis also revealed no significant differences in intraoperative complications and 5-year OS among the three surgical approaches.
Compared with laparotomy, robotic-assisted laparoscopy and laparoscopy had a shorter hospital stay, decreased blood loss, fewer complications, and transfusion happened. The 5-year OS of ovarian cancer patients has no difference between robotic-assisted laparoscopy, laparoscopy, and laparotomy groups.
我们旨在比较机器人辅助手术、传统腹腔镜手术和开腹手术治疗卵巢癌的围手术期及生存结局。
使用多个检索词在PubMed、Cochrane图书馆、Embase、Web of Science和中国知网（CNKI）中检索卵巢癌手术相关文献，包括中英文比较研究。检索截至2021年8月31日发表的文献。结局指标包括手术时间、估计失血量、住院时间、术后/术中/总并发症、盆腔/腹主动脉旁/总淋巴结清扫数量、输血情况及五年总生存率。将二分数据、连续数据和总生存率数据进行合并，分别报告为相对危险度、标准化均数差和风险比（HR）及其95%置信区间。采用纽卡斯尔-渥太华量表评估纳入研究的偏倚风险。
本网络荟萃分析纳入了38项研究，共8367例患者，涉及三种不同手术方式（机器人辅助腹腔镜手术、传统腹腔镜手术或开腹手术）。我们的分析表明，开腹手术的手术时间短于腹腔镜手术。机器人辅助腹腔镜手术术中估计失血量最少，其次是腹腔镜手术，开腹手术失血量最多。与开腹手术相比，机器人辅助腹腔镜手术组和腹腔镜手术组的输血发生率较低，住院时间较短。开腹手术的总并发症发生率显著高于机器人辅助腹腔镜手术和腹腔镜手术，术后并发症发生率高于腹腔镜手术。对于不同手术方式切除的盆腔/腹主动脉旁/总淋巴结数量，我们的分析显示无统计学差异。我们的分析还显示，三种手术方式在术中并发症和5年总生存率方面无显著差异。
与开腹手术相比，机器人辅助腹腔镜手术和腹腔镜手术住院时间更短、失血量减少、并发症更少且输血发生率更低。机器人辅助腹腔镜手术组、腹腔镜手术组和开腹手术组卵巢癌患者的5年总生存率无差异。
