Martins Russell Seth, Fatimi Asad Saulat, Mahmud Omar, Jahangir Arshia, Mahar Muhammad Umar, Aamir Syed Roohan, Khan Maria, Ahmad Ali
Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health (HMH) Network, Edison, NJ, 08820, USA.
Medical College, Aga Khan University, Karachi, 74800, Pakistan.
World J Surg. 2023 May;47(5):1310-1319. doi: 10.1007/s00268-023-06936-3. Epub 2023 Feb 14.
Maximizing patients' quality of life (QoL) is a central goal in surgical oncology. Currently, both laparoscopic and robotic surgery are viable options in rectal cancer (RC) resections. The aim of this systematic review was to analyze the differences in postoperative QoL between the two operative modalities.
This review was conducted in adherence to the PRISMA guidelines. MEDLINE, Embase, Scopus, and CENTRAL databases were searched for articles comparing QoL in patients undergoing laparoscopic versus robotic surgery for RC. Seven studies were included (two randomized controlled trials, four prospective cohorts, and one retrospective cohort) out of which six reported data suitable for meta-analysis. Global QoL and QoL subdomains, such as physical and social functioning, were meta-analyzed using a random-effects model. Risk of bias was assessed using the ROBINS-I and Cochrane RoB-2 tools.
Data on 869 patients (440 laparoscopic and 429 robotic surgery) across six studies were meta-analyzed. There was no significant difference in global QoL (Mean Difference:-0.43 [95% Confidence Interval:-3.49-2.62]). Physical functioning was superior after robotic surgery (1.92 [0.97-2.87]). However, nausea/vomiting, pain, and fatigue did not differ between groups. Perception of body image was worse after laparoscopic surgery (-5.06 [-9.05- -1.07]). Other psychosocial subdomains (emotional, cognitive, role, and social functioning) were comparable between groups.
Laparoscopic and robotic surgery for RC have comparable QoL overall, for both physical and psychological dimensions. Our results may assist the management-related decision-making in surgical treatment of RC.
最大化患者的生活质量（QoL）是外科肿瘤学的核心目标。目前，腹腔镜手术和机器人手术都是直肠癌（RC）切除术的可行选择。本系统评价的目的是分析这两种手术方式术后生活质量的差异。
本评价遵循PRISMA指南进行。检索了MEDLINE、Embase、Scopus和CENTRAL数据库，以查找比较接受腹腔镜与机器人手术治疗RC患者生活质量的文章。共纳入7项研究（2项随机对照试验、4项前瞻性队列研究和1项回顾性队列研究），其中6项报告了适合进行荟萃分析的数据。使用随机效应模型对总体生活质量和生活质量子领域（如身体和社会功能）进行荟萃分析。使用ROBINS-I和Cochrane RoB-2工具评估偏倚风险。
对6项研究中869例患者（440例行腹腔镜手术，429例行机器人手术）的数据进行了荟萃分析。总体生活质量无显著差异（平均差异：-0.43 [95%置信区间：-3.49 - 2.62]）。机器人手术后身体功能更佳（1.92 [0.97 - 2.87]）。然而，两组之间恶心/呕吐、疼痛和疲劳情况无差异。腹腔镜手术后身体形象感知较差（-5.06 [-9.05 - -1.07]）。其他心理社会子领域（情绪、认知、角色和社会功能）在两组之间相当。
RC的腹腔镜手术和机器人手术在身体和心理维度上总体生活质量相当。我们的结果可能有助于RC手术治疗中与管理相关的决策制定。
