新辅助放化疗后机器人辅助与腹腔镜手术治疗局部进展期中低位直肠癌的疗效和安全性比较：一项系统评价和荟萃分析

Comparison of efficacy and safety between robotic-assisted versus laparoscopic surgery for locally advanced mid-low rectal cancer following neoadjuvant chemoradiotherapy: a systematic review and meta-analysis.

作者信息

Zhu Xin-Mao, Bai Xiao, Wang Hai-Qi, Dai Dong-Qiu

机构信息

Department of Surgical Oncology, The Fourth Affiliated Hospital of China Medical University.

Cancer Center, The Fourth Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.

出版信息

Int J Surg. 2025 Jan 1;111(1):1154-1166. doi: 10.1097/JS9.0000000000001854.

BACKGROUND

To some extent, the robotic technique does offer certain benefits in rectal cancer surgery than laparoscopic one, while remains a topic of ongoing debate for rectal cancer patients who have undergone neoadjuvant chemoradiotherapy (NCRT).

METHODS

Potential studies published until January 2024 were obtained from Web of Science, Cochrane Library, Embase, and PubMed. Dichotomous and continuous variables were expressed as odds ratios (ORs) or weighted mean differences (WMDs) with 95% CIs, respectively. A random effects model was used if the I2 statistic >50%; otherwise, a fixed effects model was used.

RESULTS

Eleven studies involving 1079 patients were analysed. The robotic-assisted group had an 0.4 cm shorter distance from the anal verge (95% CI: -0.680 to -0.114, P =0.006) and 1.94 times higher complete total mesorectal excision (TME) rate (OR=1.936, 95% CI: 1.061-3.532, P =0.031). However, the operation time in the robotic-assisted group was 54 min longer (95% CI: 20.489-87.037, P =0.002) than the laparoscopic group. In addition, the robotic-assisted group had a lower open conversion rate (OR=0.324, 95% CI: 0.129-0.816, P =0.017) and a shorter length of hospital stay (WMD=-1.127, 95% CI: -2.071 to -0.184, P =0.019).

CONCLUSION

Robot-assisted surgery offered several advantages over laparoscopic surgery for locally advanced mid-low rectal cancer following NCRT in terms of resection of lower tumours with improved TME completeness, lower open conversion rate, and shorter hospital stay, despite the longer operative time.

背景

在某种程度上，机器人技术在直肠癌手术中确实比腹腔镜技术具有一定优势，但对于接受过新辅助放化疗（NCRT）的直肠癌患者而言，这仍是一个存在持续争议的话题。

方法

从科学网、考克兰图书馆、Embase和PubMed获取截至2024年1月发表的相关潜在研究。二分变量和连续变量分别以比值比（OR）或加权均数差（WMD）及95%置信区间表示。若I²统计量>50%，则采用随机效应模型；否则，采用固定效应模型。

结果

分析了11项涉及1079例患者的研究。机器人辅助组距肛缘距离短0.4厘米（95%置信区间：-0.680至-0.114，P =0.006），全直肠系膜切除（TME）完整率高1.94倍（OR =1.936，95%置信区间：1.061 - 3.532，P =0.031）。然而，机器人辅助组的手术时间比腹腔镜组长54分钟（95%置信区间：20.489 - 87.037，P =0.002）。此外，机器人辅助组的开腹转换率较低（OR =0.324，95%置信区间：0.129 - 0.816，P =0.017），住院时间较短（WMD = -1.127，95%置信区间：-2.071至-0.184，P =0.019）。