Morini Andrea, Zizzo Maurizio, Zanelli Magda, Sanguedolce Francesca, Palicelli Andrea, Bonelli Candida, Mangone Lucia, Fabozzi Massimiliano
Surgical Oncology Unit, Azienda USL - IRCCS Di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
Pathology Unit, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy.
Int J Colorectal Dis. 2025 Apr 2;40(1):79. doi: 10.1007/s00384-025-04859-0.
Transverse colon cancer, which accounts for approximately 10% of all colon cancers, has a significant gap in the available scientific literature regarding the optimal minimally invasive surgical approach. This meta-analysis aims to compare the robotic and laparoscopic approaches for the surgical management of transverse colon cancer.
Our systematic review made use of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, in addition to Cochrane Handbook for Systematic Reviews of Interventions. Articles of interest turned out from a search with PubMed/MEDLINE, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials-CENTRAL), Web of Science (Science and Social Science Citation Index), and Embase databases. A comprehensive literature search was conducted for comparative population studies concerning patients who underwent robotic or laparoscopic colectomy for transverse colon cancer). The risk of bias was assessed by the Cochrane Risk-of-Bias tool for randomized trials (Version 2) (RoB 2) and the Risk Of Bias In Non-randomized Studies - of Interventions (Version 2) ROBINS-I. We evaluated two groups of outcomes: intraoperative and postoperative. RevMan (Computer program) Version 5.4.1 was used to perform the meta-analysis. The heterogeneity of the included studies in the meta-analysis was assessed by using the I statist.
The 4 included comparative studies (373 patients: 116 robotic colectomy versus 257 laparoscopic colectomy) had a time frame of approximately 26 years (2005-2021) and an observational nature. Meta-analysis showed a longer operative time (MD: 62.47, 95% CI: 18.17, 106.76, I = 92%, P = 0.006) and a shorter hospital stay (MD:-1.11, 95% CI: -2.05, -0.18, I = 63%, P = 0.002) for the robotic group. No differences in terms of conversion to laparotomy, estimated blood loss, time to flatus, time to solid diet, overall postoperative complications rate, minor (Clavien-Dindo or CD I-II) and major (Clavien-Dindo or CD ≥ III) postoperative complications rate, anastomotic leakage, surgical site infections, bleeding, lymph nodes harvested, were shown between robotic and laparoscopic groups.
Our meta-analysis revealed that the robotic approach to transverse colon cancer appears to be a safe and feasible option, with results comparable to those of laparoscopic surgery, with longer operating times but a shorter hospital stay. Further high-quality methodological studies are needed to evaluate and compare the short- and long-term outcomes, healthcare costs, and the learning curve between the robotic and laparoscopic surgical approaches.
横结肠癌约占所有结肠癌的10%，在关于最佳微创手术方法的现有科学文献中存在显著空白。本荟萃分析旨在比较机器人手术和腹腔镜手术治疗横结肠癌的效果。
我们的系统评价除采用《Cochrane干预措施系统评价手册》外，还利用了系统评价和荟萃分析的首选报告项目（PRISMA）指南。通过PubMed/MEDLINE、Cochrane图书馆（Cochrane系统评价数据库、Cochrane对照试验中央注册库CENTRAL）、科学网（科学和社会科学引文索引）和Embase数据库进行检索，找出感兴趣的文章。对关于接受机器人或腹腔镜横结肠癌切除术患者的比较性人群研究进行了全面的文献检索。采用Cochrane随机试验偏倚风险工具（第2版）（RoB 2）和非随机干预性研究中的偏倚风险（第2版）ROBINS-I评估偏倚风险。我们评估了两组结果：术中结果和术后结果。使用RevMan（计算机程序）5.4.1版进行荟萃分析。采用I统计量评估荟萃分析中纳入研究的异质性。
纳入的4项比较研究（373例患者：116例行机器人结肠切除术，257例行腹腔镜结肠切除术）的时间跨度约为26年（2005 - 2021年），具有观察性。荟萃分析显示，机器人手术组的手术时间更长（MD：62.47，95%CI：18.17，106.76，I = 92%，P = 0.006），住院时间更短（MD：-1.11，95%CI：-2.05，-0.18，I = 63%，P = 0.002）。机器人手术组和腹腔镜手术组在中转开腹、估计失血量、排气时间、开始正常饮食时间、总体术后并发症发生率、轻微（Clavien-Dindo或CD I-II级）和严重（Clavien-Dindo或CD≥III级）术后并发症发生率、吻合口漏、手术部位感染、出血、清扫淋巴结数量等方面均无差异。
我们的荟萃分析表明，机器人手术治疗横结肠癌似乎是一种安全可行的选择，其结果与腹腔镜手术相当，手术时间较长但住院时间较短。需要进一步开展高质量的方法学研究，以评估和比较机器人手术和腹腔镜手术的短期和长期结果、医疗成本以及学习曲线。
