Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China.
Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Medical School of Nanjing University, Yangzhou, Jiangsu Province, China.
Tech Coloproctol. 2023 Jul;27(7):521-535. doi: 10.1007/s10151-023-02821-2. Epub 2023 May 15.
For right colon surgery, there is an increasing body of literature comparing the safety of robotic right colectomy (RRC) with laparoscopic right colectomy (LRC). The aim of the present systematic review and meta-analysis is to assess the safety and efficacy of RRC versus LRC, including homogeneous subgroup analyses for extracorporeal anastomosis (EA) and intracorporeal anastomosis (IA).
PubMed, Web of Science, Embase, and Cochrane Library databases were searched for studies published between January 2000 and January 2022. Length of hospital stay, operation time, rate of conversion to laparotomy, time to first flatus, number of harvested lymph nodes, estimated blood loss, rate of overall complication, ileus, anastomotic leakage, wound infection, and total costs were measured.
Forty-two studies (RRC: 2772 patients; LRC: 12,469 patients) were evaluated. Regardless of the type of anastomosis, RRC showed shorter length of hospital stay, lower rate of conversion to laparotomy, shorter time to first flatus, lower rate of overall complications, and a higher number of harvested lymph nodes compared with LRC, but longer operative time and higher total costs. In the IA subgroup, RRC had a shorter length of hospital stay, longer operative time, and lower rate of conversion to laparotomy compared with LRC, with no difference for the remaining outcomes. In the EA subgroup, RRC had a longer operative time, lower estimated blood loss, lower rate of overall complications, and higher total costs compared with LRC, with the other outcomes being similar.
The safety and efficacy of RRC is superior to LRC, especially when an intracorporeal anastomosis is performed. Most included articles were retrospective, offering low-quality evidence and limited conclusions.
对于右半结肠癌手术，越来越多的文献比较了机器人右半结肠切除术（RRC）与腹腔镜右半结肠切除术（LRC）的安全性。本系统评价和荟萃分析的目的是评估 RRC 与 LRC 的安全性和疗效，包括体外吻合（EA）和体内吻合（IA）的同质亚组分析。
检索 2000 年 1 月至 2022 年 1 月期间发表的 PubMed、Web of Science、Embase 和 Cochrane 图书馆数据库的研究。测量住院时间、手术时间、中转开腹率、首次排气时间、淋巴结清扫数目、估计失血量、总并发症发生率、肠梗阻、吻合口漏、伤口感染和总费用。
共评估了 42 项研究（RRC：2772 例；LRC：12469 例）。无论吻合方式如何，RRC 与 LRC 相比，住院时间更短，中转开腹率更低，首次排气时间更早，总并发症发生率更低，淋巴结清扫数目更多，但手术时间更长，总费用更高。在 IA 亚组中，RRC 与 LRC 相比，住院时间更短，手术时间更长，中转开腹率更低，但其余结果无差异。在 EA 亚组中，RRC 与 LRC 相比，手术时间更长，估计失血量更少，总并发症发生率更低，总费用更高，但其他结果相似。
RRC 的安全性和疗效优于 LRC，尤其是在进行体内吻合时。大多数纳入的文章都是回顾性的，提供的证据质量低，结论有限。
