COMPARE研究：比较肿瘤微创腹腔镜手术、达芬奇机器人手术和开放手术的围手术期结局：证据的系统评价和荟萃分析
The COMPARE Study: Comparing Perioperative Outcomes of Oncologic Minimally Invasive Laparoscopic, da Vinci Robotic, and Open Procedures: A Systematic Review and Meta-analysis of the Evidence.
作者信息
Ricciardi Rocco, Seshadri-Kreaden Usha, Yankovsky Ana, Dahl Douglas, Auchincloss Hugh, Patel Neera M, Hebert April E, Wright Valena
机构信息
Department of Surgery, Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, MA.
Biostatistics and Global Access and Evidence Management, Intuitive Surgical, Sunnyvale, CA.
出版信息
Ann Surg. 2025 May 1;281(5):748-763. doi: 10.1097/SLA.0000000000006572. Epub 2024 Oct 22.
OBJECTIVE
To assess 30-day outcomes of da Vinci robotic-assisted (dV-RAS) versus laparoscopic or video-assisted thoracoscopic (lap/VATS) or open oncologic surgery.
BACKGROUND
Complex procedures in deep/narrow spaces especially benefit from dV-RAS. Prior procedure-specific comparisons are not generalizable.
METHODS
PubMed, Scopus, and EMBASE were systematically searched (latest: November 17, 2023) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and PROSPERO (Reg#CRD42023466759). Randomized, prospective, and database studies were pooled as odds ratios (ORs) or mean differences (MDs) in R using fixed effects or random effects (heterogeneity significant). ROBINS-I/RoB 2 were used to assess bias.
RESULTS
Of 56,314 unique references over 12 years from 22 countries, 230 studies (34 randomized, 74 prospective, and 122 database) comparing dV-RAS to lap/VATS or open surgery across 7 procedures, 4 specialties, representing 1,194,559 dV-RAS; 1,095,936 lap/VATS and 1,625,320 open cases were included. Operative time for dV-RAS was longer than lap/VATS [MD: 17.73 minutes (9.80, 25.67), P < 0.01] and open surgery [MD: 40.92 minutes (28.83, 53.00), P < 0.01], whereas hospital stay was shorter [lap/VATS MD: -0.51 days (-0.64, -0.38), P < 0.01; open MD: -1.85 days (-2.09, -1.62), P < 0.01] and blood loss was less versus open [MD: -293.44 mL (-359.53, -227.35)]. There were fewer dV-RAS conversions [OR: 0.44 (0.40, 0.49), P < 0.01], transfusions [OR: 0.79 (0.72, 0.88), P < 0.01], postoperative complications [OR: 0.90 (0.84, 0.96), P < 0.01], readmissions [OR: 0.91 (0.83, 0.99), P = 0.04], and deaths [OR: 0.86 (0.81, 0.92), P < 0.01] versus lap/VATS, and fewer transfusions [OR: 0.25 (0.21, 0.30), P < 0.01], postoperative complications [OR: 0.56 (0.52, 0.61), P < 0.01], readmissions [OR: 0.71 (0.63, 0.81), P < 0.01], operations [OR: 0.89 (0.81, 0.97), P < 0.01], and deaths [OR: 0.54 (0.47, 0.63), P < 0.01] versus open surgery. Blood loss [MD:- 12.26 mL (-29.44, 4.91), P = 0.16] and operations [OR: 1.03 (0.95, 1.11), P = 0.48] were similar for dV-RAS and lap/VATS. There was significant heterogeneity.
CONCLUSIONS
Da Vinci-RAS confers benefits across oncological procedures and study designs. These results provide clinical evidence to multispecialty-care decision-makers considering dV-RAS.
目的
评估达芬奇机器人辅助手术（dV-RAS）与腹腔镜或电视辅助胸腔镜手术（lap/VATS）或开放肿瘤手术的30天结局。
背景
在深部/狭窄空间进行的复杂手术尤其受益于dV-RAS。先前特定手术的比较结果不具有普遍性。
方法
按照系统评价和Meta分析的首选报告项目以及PROSPERO（注册号：CRD42023466759）对PubMed、Scopus和EMBASE进行系统检索（最新检索时间：2023年11月17日）。将随机、前瞻性和数据库研究合并为比值比（OR）或平均差（MD），采用固定效应或随机效应模型（异质性显著）。使用ROBINS-I/RoB 2评估偏倚。
结果
在来自22个国家的12年中检索到的56314篇独特参考文献中，有230项研究（34项随机研究、74项前瞻性研究和122项数据库研究）比较了dV-RAS与lap/VATS或开放手术，涉及7种手术、4个专科，包括1194559例dV-RAS手术、1095936例lap/VATS手术和1625320例开放手术病例。dV-RAS的手术时间长于lap/VATS [MD：17.73分钟（9.80，25.67），P < 0.01]和开放手术[MD：40.92分钟（28.83，53.00），P < 0.01]，而住院时间较短[lap/VATS MD：-0.51天（-0.64，-0.38），P < 0.01；开放手术MD：-1.85天（-2.09，-1.62），P < 0.01]，与开放手术相比失血较少[MD：-293.44 mL（-359.53，-227.35）]。dV-RAS的中转率较低[OR：0.44（0.40，0.49），P < 0.01]，输血率较低[OR：0.79（0.72，0.88），P < 0.01]，术后并发症较少[OR：0.90（0.84，0.96），P < 0.01]，再入院率较低[OR：0.91（0.83，0.99），P = 0.04]，死亡率较低[OR：0.86（0.81，0.92），P < 0.01]，与lap/VATS相比，输血率较低[OR：0.25（0.21，0.30），P < 0.01]，术后并发症较少[OR：0.56（0.52，0.61），P < 0.01]，再入院率较低[OR：0.71（0.63，0.81），P < 0.01]，手术率较低[OR：0.89（0.81，0.97），P < 0.01]，死亡率较低[OR：0.54（0.47，0.63），P < 0.01]，与开放手术相比。dV-RAS与lap/VATS的失血量[MD：-12.26 mL（-29.44，4.91），P = 0.16]和手术率[OR：1.03（0.95，1.11），P = 0.48]相似。存在显著异质性。
结论
达芬奇机器人辅助手术在肿瘤手术和研究设计中均具有优势。这些结果为考虑采用dV-RAS的多专科护理决策者提供了临床证据。
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