Tschann Peter, Szeverinski Philipp, Weigl Markus P, Rauch Stephanie, Lechner Daniel, Adler Stephanie, Girotti Paolo N C, Clemens Patrick, Tschann Veronika, Presl Jaroslav, Schredl Philipp, Mittermair Christof, Jäger Tarkan, Emmanuel Klaus, Königsrainer Ingmar
Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria.
Institute of Medical Physics, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria.
J Clin Med. 2022 Apr 24;11(9):2387. doi: 10.3390/jcm11092387.
Background: There is a rapidly growing literature available on right hemicolectomy comparing the short- and long-term outcomes of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). The aim of this meta-analysis is to revise current comparative literature systematically. Methods: A systematic review of comparative studies published between 2000 to 2021 in PubMed, Scopus and Embase was performed. The primary endpoint was postoperative morbidity, mortality and long-term oncological results. Secondary endpoints consist of blood loss, conversion rates, complications, time to first flatus, hospital stay and incisional hernia rate. Results: 25 of 322 studies were considered for data extraction. A total of 16,099 individual patients who underwent RRC (n = 1842) or LRC (n = 14,257) between 2002 and 2020 were identified. Operative time was significantly shorter in the LRC group (LRC 165.31 min ± 43.08 vs. RRC 207.38 min ± 189.13, MD: −42.01 (95% CI: −51.06−32.96), p < 0.001). Blood loss was significantly lower in the RRC group (LRC 63.57 ± 35.21 vs. RRC 53.62 ± 34.02, MD: 10.03 (95% CI: 1.61−18.45), p = 0.02) as well as conversion rate (LRC 1155/11,629 vs. RRC 94/1534, OR: 1.65 (1.28−2.13), p < 0.001) and hospital stay (LRC 6.15 ± 31.77 vs. RRC 5.31 ± 1.65, MD: 0.84 (95% CI: 0.29−1.38), p = 0.003). Oncological long-term results did not differ between both groups. Conclusion: The advantages of robotic colorectal procedures were clearly demonstrated. RRC can be regarded as safe and feasible. Most of the included studies were retrospective with a limited level of evidence. Further randomized trials would be suitable.
关于右半结肠切除术，比较机器人辅助右半结肠切除术（RRC）与腹腔镜右半结肠切除术（LRC）短期和长期结局的文献正在迅速增加。本荟萃分析的目的是系统地回顾当前的比较文献。方法：对2000年至2021年在PubMed、Scopus和Embase上发表的比较研究进行系统综述。主要终点是术后发病率、死亡率和长期肿瘤学结果。次要终点包括失血量、中转率、并发症、首次排气时间、住院时间和切口疝发生率。结果：322项研究中有25项被纳入数据提取。共确定了2002年至2020年间接受RRC（n = 1842）或LRC（n = 14257）的16099例个体患者。LRC组的手术时间明显更短（LRC 165.31分钟±43.08 vs. RRC 207.38分钟±189.13，MD：−42.01（95%CI：−51.06−32.96），p < 0.001）。RRC组的失血量明显更低（LRC 63.57±35.21 vs. RRC 53.62±34.02，MD：10.03（95%CI：1.61−18.45），p = 0.02），中转率（LRC 1155/11629 vs. RRC 94/1534，OR：1.65（1.28−2.13），p < 0.001）和住院时间（LRC 6.15±31.77 vs. RRC 5.31±1.65，MD：0.84（95%CI：0.29−1.38），p = 0.003）也更低。两组的长期肿瘤学结果没有差异。结论：机器人结直肠手术的优势得到了明确证明。RRC可被视为安全可行的。纳入的大多数研究是回顾性的，证据水平有限。进一步的随机试验将是合适的。
