Universitätsmedizin Mannheim, Heidelberg University, Germany.
Queen Alexandra Hospital, UK.
Ann R Coll Surg Engl. 2023 Feb;105(2):113-125. doi: 10.1308/rcsann.2022.0051. Epub 2022 Aug 11.
This systematic review with meta-analysis aimed to compare the robotic complete mesocolon excision (RCME) to laparoscopic colectomy (LC) with (LCME) or without CME (LC non-CME) in postoperative outcomes, harvested lymph nodes and disease-free survival.
We performed a systematic review with meta-analysis according to PRISMA 2020 and AMSTAR 2 guidelines.
The literature search yielded seven comparative studies including 677 patients: 269 patients in the RCME group and 408 in the LC group. The pooled analysis concluded to a lower conversion rate in the RCME group (OR=0.17; 95% CI [0.04, 0.74], =0.02). There was no difference between the two groups in terms of morbidity (OR=1.03; 95% CI [0.70, 1.53], =0.87), anastomosis leakage (OR=0.83; 95% CI [0.18, 3.72], =0.81), bleeding (OR=1.90; 95% CI [0.64, 5.58], =0.25), wound infection (OR=1.37; 95% CI [0.51, 3.68], =0.53), operative time (mean difference (MD)=36.32; 95% CI [-24.30, 96.93], =0.24), hospital stay (MD=-0.94; 95% CI [-2.03, 0.15], =0.09) and disease-free survival (OR=1.29; 95% CI [0.71, 2.35], =0.41). In the subgroup analysis, the operative time was significantly shorter in the LCME group than RCME group (MD=50.93; 95% CI [40.05, 61.81], <0.01) and we noticed a greater number of harvested lymph nodes in the RCME group compared with LC non-CME group (MD=8.96; 95% CI [5.98, 11.93], <0.01).
The robotic approach for CME ensures a lower conversion rate than the LC. RCME had a longer operative time than the LCME subgroup and a higher number of harvested lymph nodes than the LC non-CME group.
本系统评价和荟萃分析旨在比较机器人完整结肠系膜切除术（RCME）与腹腔镜结肠切除术（LC）联合（LCME）或不联合 CME（LC 非-CME）在术后结果、采集的淋巴结和无病生存率方面的差异。
我们根据 PRISMA 2020 和 AMSTAR 2 指南进行了系统评价和荟萃分析。
文献检索共纳入 7 项比较研究，包括 677 名患者：RCME 组 269 例，LC 组 408 例。汇总分析得出 RCME 组的转化率较低（OR=0.17；95%CI[0.04,0.74]，=0.02）。两组在发病率（OR=1.03；95%CI[0.70,1.53]，=0.87）、吻合口漏（OR=0.83；95%CI[0.18,3.72]，=0.81）、出血（OR=1.90；95%CI[0.64,5.58]，=0.25）、伤口感染（OR=1.37；95%CI[0.51,3.68]，=0.53）、手术时间（平均差值（MD）=36.32；95%CI[-24.30,96.93]，=0.24）、住院时间（MD=-0.94；95%CI[-2.03,0.15]，=0.09）和无病生存率（OR=1.29；95%CI[0.71,2.35]，=0.41）方面无差异。在亚组分析中，LCME 组的手术时间明显短于 RCME 组（MD=50.93；95%CI[40.05,61.81]，<0.01），而 RCME 组采集的淋巴结数量明显多于 LC 非-CME 组（MD=8.96；95%CI[5.98,11.93]，<0.01）。
机器人 CME 方法比 LC 方法具有更低的转化率。RCME 的手术时间长于 LCME 亚组，采集的淋巴结数量多于 LC 非-CME 组。
