Robot-assisted versus conventional laparoscopic operation in anus-preserving rectal cancer: a meta-analysis

• Main Authors: Cui Y, Li C, Xu Z, Wang Y, Sun Y, Xu H, Li Z
• Format: Article
• Language: English
• Published: Dove Medical Press 2017-09-01
• Series: Therapeutics and Clinical Risk Management
• Subjects: Rectal cancer. Da Vinci surgical system. Laparoscopic surgery. Anus-preserving operation. Meta-analysis
• Online Access: https://www.dovepress.com/robot-assisted-versus-conventional-laparoscopic-operation-in-anus-pres-peer-reviewed-article-TCRM

Yongzhen Cui,1,2,* Cheng Li,3,* Zhongfa Xu,4 Yingming Wang,1,2 Yamei Sun,5 Huirong Xu,1 Zengjun Li,1 Yanlai Sun1 1Department of Gastrointestinal Cancer Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 2School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, 3Department of President’s Office, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 4Department of Gastrointestinal Surgery, The Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, 5Department of Clinical Laboratory, Zhucheng People’s Hospital of Shandong Province, Zhucheng, People’s Republic of China *These authors contributed equally to this work Objective: The aim of this meta-analysis is to provide recommendations for clinical practice and prevention of postoperative complications, such as circumferential resection margin (CRM) involvement, and compare the amount of intraoperative bleeding, safety, operative time, recovery, outcomes, and clinical significance of robot-assisted and conventional laparoscopic procedures in anus-preserving rectal cancer. Methods: A literature search (PubMed) was performed to identify biomedical research papers and abstracts of studies comparing robot-assisted and conventional laparoscopic procedures. We attempted to obtain the full-text link for papers published between 2000 and 2016, and hand-searched references for relevant literature. RevMan 5.3 software was used for the meta-analysis. Results: Nine papers (949 patients) were eligible for inclusion; there were 473 patients (49.8%) in the robotic group and 476 patients (50.2%) in the laparoscopic group. According to the data provided in the literature, seven indicators were used to complete the evaluation. The results of the meta-analysis suggested that robot-assisted procedure was associated with lower intraoperative blood loss (mean difference [MD] -41.15; 95% confidence interval [CI] -77.51, -4.79; P=0.03), lower open conversion rate (risk difference [RD] -0.05; 95% CI -0.09, -0.01; P=0.02), lower hospital stay (MD -1.07; 95% CI -1.80, -0.33; P=0.005), lower overall complication rate (odds ratio 0.58; 95% CI 0.41, 0.83; P=0.003), and longer operative time (MD 33.73; 95% CI 8.48, 58.99; P=0.009) compared with conventional laparoscopy. There were no differences in the rate of CRM involvement (RD -0.02; 95% CI -0.05, 0.01; P=0.23) and days to return of bowel function (MD -0.03; 95% CI -0.40, 0.34; P=0.89). Conclusion: The Da Vinci robot was superior to laparoscopy with respect to blood loss, open conversion, hospital stay, and postoperative complications during anus-preserving rectal cancer procedures; however, conventional laparoscopy had an advantage regarding operative time. The remaining indicators (CRMs and recovery from intestinal peristalsis) did not differ. Keywords: rectal cancer, Da Vinci surgical system, laparoscopic surgery, anus-preserving operation, meta-analysis