RECOURSE 研究：机器人辅助微创治疗子宫内膜癌、宫颈癌、结直肠癌、肺癌或前列腺癌的长期肿瘤学结局：系统评价和荟萃分析。
The RECOURSE Study: Long-term Oncologic Outcomes Associated With Robotically Assisted Minimally Invasive Procedures for Endometrial, Cervical, Colorectal, Lung, or Prostate Cancer: A Systematic Review and Meta-analysis.
机构信息
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY.
Department of Obstetrics and Gynecology, Weill Cornell Medical College, NY, NY.
出版信息
Ann Surg. 2023 Mar 1;277(3):387-396. doi: 10.1097/SLA.0000000000005698. Epub 2022 Sep 8.
OBJECTIVE
To assess long-term outcomes with robotic versus laparoscopic/thoracoscopic and open surgery for colorectal, urologic, endometrial, cervical, and thoracic cancers.
BACKGROUND
Minimally invasive surgery provides perioperative benefits and similar oncological outcomes compared with open surgery. Recent robotic surgery data have questioned long-term benefits.
METHODS
A systematic review and meta-analysis of cancer outcomes based on surgical approach was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using Pubmed, Scopus, and Embase. Hazard ratios for recurrence, disease-free survival (DFS), and overall survival (OS) were extracted/estimated using a hierarchical decision tree and pooled in RevMan 5.4 using inverse-variance fixed-effect (heterogeneity nonsignificant) or random effect models.
RESULTS
Of 31,204 references, 199 were included (7 randomized, 23 database, 15 prospective, 154 retrospective studies)-157,876 robotic, 68,007 laparoscopic/thoracoscopic, and 234,649 open cases. Cervical cancer: OS and DFS were similar between robotic and laparoscopic [1.01 (0.56, 1.80), P =0.98] or open [1.18 (0.99, 1.41), P =0.06] surgery; 2 papers reported less recurrence with open surgery [2.30 (1.32, 4.01), P =0.003]. Endometrial cancer: the only significant result favored robotic over open surgery [OS; 0.77 (0.71, 0.83), P <0.001]. Lobectomy: DFS favored robotic over thoracoscopic surgery [0.74 (0.59, 0.93), P =0.009]; OS favored robotic over open surgery [0.93 (0.87, 1.00), P =0.04]. Prostatectomy: recurrence was less with robotic versus laparoscopic surgery [0.77 (0.68, 0.87), P <0.0001]; OS favored robotic over open surgery [0.78 (0.72, 0.85), P <0.0001]. Low-anterior resection: OS significantly favored robotic over laparoscopic [0.76 (0.63, 0.91), P =0.004] and open surgery [0.83 (0.74, 0.93), P =0.001].
CONCLUSIONS
Long-term outcomes were similar for robotic versus laparoscopic/thoracoscopic and open surgery, with no safety signal or indication requiring further research (PROSPERO Reg#CRD42021240519).
目的
评估机器人手术与腹腔镜/胸腔镜和开放手术治疗结直肠、泌尿科、妇科、妇科和胸科癌症的长期结果。
背景
微创手术与开放手术相比具有围手术期优势和相似的肿瘤学结果。最近的机器人手术数据对长期获益提出了质疑。
方法
根据外科手术方法，基于系统评价和荟萃分析的首选报告项目，使用 Pubmed、Scopus 和 Embase 进行了癌症结果的系统评价和荟萃分析。使用分层决策树提取/估计复发、无病生存率（DFS）和总生存率（OS）的风险比，并使用 RevMan 5.4 使用逆方差固定效应（异质性不显著）或随机效应模型进行汇总。
结果
在 31204 篇参考文献中，纳入了 199 篇（7 项随机对照试验、23 项数据库、15 项前瞻性研究、154 项回顾性研究）-157876 例机器人手术、68007 例腹腔镜/胸腔镜手术和 234649 例开放手术。宫颈癌：机器人与腹腔镜[1.01（0.56，1.80），P=0.98]或开放[1.18（0.99，1.41），P=0.06]手术的 OS 和 DFS 相似；2 篇论文报告开放手术复发率较低[2.30（1.32，4.01），P=0.003]。子宫内膜癌：唯一有意义的结果是机器人手术优于开放手术[OS；0.77（0.71，0.83），P<0.001]。肺叶切除术：DFS 机器人手术优于胸腔镜手术[0.74（0.59，0.93），P=0.009]；OS 机器人手术优于开放手术[0.93（0.87，1.00），P=0.04]。前列腺切除术：与腹腔镜手术相比，机器人手术的复发率较低[0.77（0.68，0.87），P<0.0001]；OS 机器人手术优于开放手术[0.78（0.72，0.85），P<0.0001]。低位前切除术：OS 机器人手术明显优于腹腔镜[0.76（0.63，0.91），P=0.004]和开放手术[0.83（0.74，0.93），P=0.001]。
结论
机器人手术与腹腔镜/胸腔镜和开放手术的长期结果相似，没有安全性信号或需要进一步研究的指征（PROSPERO 注册号 CRD42021240519）。
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