Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
J Robot Surg. 2024 Apr 8;18(1):166. doi: 10.1007/s11701-024-01882-1.
Current meta-analysis was performed to compare robotic hepatectomy (RH) with conventional open hepatectomy (OH) in terms of peri-operative and postoperative outcomes. PubMed, EMBASE, and the Cochrane Library were all searched up for comparative studies between RH and OH. RevMan5.3 software and Stata 13.0 software were used for statistical analysis. Nineteen studies with 1747 patients who received RH and 23,633 patients who received OH were included. Pooled results indicated that patients who received RH were generally younger than those received OH (P < 0.00001). Moreover, RH was associated with longer operative time (P = 0.0002), less intraoperative hemorrhage (P < 0.0001), lower incidence of intraoperative transfusion (P = 0.003), lower incidence of postoperative any morbidity (P < 0.00001), postoperative major morbidity (P = 0.0001), mortalities with 90 days after surgery (P < 0.0001), and shorter length of postoperative hospital stay (P < 0.00001). Comparable total hospital costs were acquired between RH and OH groups (P = 0.46). However, even at the premise of comparable R0 rate (P = 0.86), RH was associated with smaller resected tumor size (P < 0.00001). Major hepatectomy (P = 0.02) and right posterior hepatectomy (P = 0.0003) were less frequently performed in RH group. Finally, we concluded that RH was superior to OH in terms of peri-operative and postoperative outcomes. RH could lead to less intraoperative hemorrhage, less postoperative complications and an enhanced postoperative recovery. However, major hepatectomy and right posterior hepatectomy were still less frequently performed via robotic approach. Future more powerful well-designed studies are required for further exploration.
本研究旨在比较机器人肝切除术（RH）与传统开腹肝切除术（OH）在围手术期和术后结果方面的差异。检索了 PubMed、EMBASE 和 Cochrane Library 中的所有比较研究。使用 RevMan5.3 软件和 Stata13.0 软件进行统计分析。共纳入 19 项研究，其中 1747 例患者接受 RH，23633 例患者接受 OH。汇总结果表明，接受 RH 的患者通常比接受 OH 的患者年轻（P<0.00001）。此外，RH 手术时间较长（P=0.0002），术中出血量较少（P<0.0001），术中输血发生率较低（P=0.003），术后任何并发症发生率较低（P<0.00001），术后主要并发症发生率较低（P=0.0001），术后 90 天死亡率较低（P<0.0001），术后住院时间较短（P<0.00001）。RH 组和 OH 组的总住院费用相当（P=0.46）。但是，即使在 R0 切除率相当的前提下（P=0.86），RH 组的切除肿瘤体积也较小（P<0.00001）。RH 组较少行大肝癌切除术（P=0.02）和右后叶肝切除术（P=0.0003）。总之，RH 在围手术期和术后结果方面优于 OH。RH 可减少术中出血，减少术后并发症，促进术后恢复。然而，机器人手术在进行大肝癌和右后叶肝切除时仍较少采用。需要进一步开展更多设计严谨的高质量研究来进行深入探讨。
