Zou Jingyu, Zhu Heyuan, Tang Yongqin, Huang Ying, Chi Pan, Wang Xiaojie
Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.
BMC Surg. 2025 Feb 28;25(1):86. doi: 10.1186/s12893-025-02805-z.
The usage of robotic surgery in rectal cancer was increasing, but there was an ongoing debate as to whether it provided any benefit. The aim of this study was to evaluate the safety, efficacy, and prognosis of elective rectal resection for rectal cancer by robotic surgery compared with conventional laparoscopic surgery.
Electronic databases were searched from their inception to 1 February 2024, for randomized controlled trials (RCTs) involving a comparison between robotic surgery (RS) and laparoscopic surgery (LS) and performed a meta-analysis of all RCTs according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
11 RCTs including a total of 3107 cases were identified. Compared with LS, RS had a significantly lower conversion rate (odds ratio: 0.42; 95% confidence interval: 0.28 to 0.63; P < 0.0001), lower reoperation rate (odds ratio: 0.454; 95% confidence interval: 0.31 to 0.94; P = 0.03), more lymph nodes harvested (mean difference: 0.67; 95% confidence interval: 0.30 to 1.04; P = 0.0004), a smaller incidence of positive circumferential margin (CRM) (odds ratio: 0.59; 95% confidence interval: 0.41 to 0.85; P = 0.004). RS had less time to first autonomous urination (mean difference: -0.78; 95% confidence interval: -1.15 to -0.41; P < 0.0001), less time to first defecation (mean difference: -0.40; 95% confidence interval: -0.78 to -0.01; P = 0.04) and less time to first flatus (mean difference: -0.45; 95% confidence interval: -0.89 to -0.01; P = 0.04), more operating time (mean difference: 23.46; 95% confidence interval: 15.76 to 31.16; P < 0.00001). Overall postoperative complication, short-term postoperative complication, estimate blood loss, hospital stays, Intraoperative complication, postoperative mortality, preventive ostomy rates, readmission did not differ significantly between approaches. (P > 0.05).
Compared to laparoscopic surgery, robotic surgery demonstrated superior safety, efficacy, and prognosis. This meta-analysis supports that RS is a safe and effective option.
机器人手术在直肠癌治疗中的应用日益增加，但对于其是否具有任何益处仍存在争议。本研究的目的是评估与传统腹腔镜手术相比，机器人手术用于直肠癌择期直肠切除术的安全性、有效性和预后。
检索电子数据库自建库至2024年2月1日的数据，查找涉及机器人手术（RS）与腹腔镜手术（LS）比较的随机对照试验（RCT），并根据系统评价和Meta分析的首选报告项目（PRISMA）指南对所有RCT进行Meta分析。
共纳入11项RCT，总计3107例患者。与LS相比，RS的中转率显著更低（比值比：0.42；95%置信区间：0.28至0.63；P < 0.0001），再次手术率更低（比值比：0.454；95%置信区间：0.31至0.94；P = 0.03），清扫的淋巴结更多（平均差值：0.67；95%置信区间：0.30至1.04；P = 0.0004），环周切缘（CRM）阳性发生率更低（比值比：0.59；95%置信区间：0.41至0.85；P = 0.004）。RS患者首次自主排尿时间更短（平均差值：-0.78；95%置信区间：-1.15至-0.41；P < 0.0001），首次排便时间更短（平均差值：-0.40；95%置信区间：-0.78至-0.01；P = 0.04），首次排气时间更短（平均差值：-0.45；95%置信区间：-0.89至-0.01；P = 0.04），手术时间更长（平均差值：23.46；95%置信区间：15.76至31.16；P < 0.00001）。两种手术方式在总体术后并发症、短期术后并发症、估计失血量、住院时间、术中并发症、术后死亡率、预防性造口率、再入院率方面差异均无统计学意义（P > 0.05）。
与腹腔镜手术相比，机器人手术显示出更高的安全性、有效性和更好的预后。本Meta分析支持RS是一种安全有效的选择。
