Karem Slim , Gilles Tilmans , Bob Valéry Occéan , Chadly Dziri , Bruno Pereira , Michel Canis
{"title":"Meta-analysis of randomized clinical trials comparing robotic versus laparoscopic surgery for mid-low rectal cancers","authors":"Karem Slim , Gilles Tilmans , Bob Valéry Occéan , Chadly Dziri , Bruno Pereira , Michel Canis","doi":"10.1016/j.jviscsurg.2024.01.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Robotic surgery (RS) is experiencing major development, particularly in the context of rectal cancer. The aim of this meta-analysis was to summarize data from the literature, focusing specifically on the safety and effectiveness of robotic surgery in mid-low rectal cancers, based on the hypothesis that that robotic surgery can find its most rational indication in this anatomical location.</p></div><div><h3>Method</h3><p>The meta-analysis was conducted according to the PRISMA 2000 recommendations, including all randomized trials that compared robotic surgery <em>versus</em> laparoscopic surgery (LS) that were found in the Medline-PICO, Cochrane Database, Scopus and Google databases. Data were extracted independently by two reviewers. The risk of bias was analyzed according to the Cochrane Handbook method and the certainty of the evidence according to the GRADE method. The analysis was carried out with R software Version 4.2-3 using the Package for Meta-Analysis “meta” version 6.5-0.</p></div><div><h3>Results</h3><p>Eight randomized trials were included (with a total of 2342 patients), including four that focused specifically on mid-low rectal cancer (<em>n</em> <!-->=<!--> <!-->1,734 patients). No statistically significant difference was found for overall morbidity, intra-operative morbidity, anastomotic leakage, post-operative mortality, quality of mesorectal specimen, and resection margins. The main differences identified were a lower conversion rate for RS (RR<!--> <!-->=<!--> <!-->0.48 [0.24–0.95], <em>p<!--> </em>=<!--> <!-->0.04, I<sup>2</sup> <!-->=<!--> <!-->0%), and a longer operative time for RS (mean difference<!--> <!-->=<!--> <!-->39.11<!--> <!-->min [9.39–68.83], <em>p</em> <!--><<!--> <!-->0.01, I<sup>2</sup> <!-->=<!--> <!-->96%). The other differences had no real clinical relevance, i.e., resumption of flatus passage (5<!--> <!-->hours earlier after RS), and lymph node dissection (one more lymph node for LS).</p></div><div><h3>Conclusion</h3><p>This meta-analysis does not confirm the initial hypothesis and does not show a statistically significant or clinically relevant benefit of RS compared to LS for mid-low rectal cancer.</p></div>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Visceral Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878788624000043","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
Robotic surgery (RS) is experiencing major development, particularly in the context of rectal cancer. The aim of this meta-analysis was to summarize data from the literature, focusing specifically on the safety and effectiveness of robotic surgery in mid-low rectal cancers, based on the hypothesis that that robotic surgery can find its most rational indication in this anatomical location.
Method
The meta-analysis was conducted according to the PRISMA 2000 recommendations, including all randomized trials that compared robotic surgery versus laparoscopic surgery (LS) that were found in the Medline-PICO, Cochrane Database, Scopus and Google databases. Data were extracted independently by two reviewers. The risk of bias was analyzed according to the Cochrane Handbook method and the certainty of the evidence according to the GRADE method. The analysis was carried out with R software Version 4.2-3 using the Package for Meta-Analysis “meta” version 6.5-0.
Results
Eight randomized trials were included (with a total of 2342 patients), including four that focused specifically on mid-low rectal cancer (n = 1,734 patients). No statistically significant difference was found for overall morbidity, intra-operative morbidity, anastomotic leakage, post-operative mortality, quality of mesorectal specimen, and resection margins. The main differences identified were a lower conversion rate for RS (RR = 0.48 [0.24–0.95], p = 0.04, I2 = 0%), and a longer operative time for RS (mean difference = 39.11 min [9.39–68.83], p < 0.01, I2 = 96%). The other differences had no real clinical relevance, i.e., resumption of flatus passage (5 hours earlier after RS), and lymph node dissection (one more lymph node for LS).
Conclusion
This meta-analysis does not confirm the initial hypothesis and does not show a statistically significant or clinically relevant benefit of RS compared to LS for mid-low rectal cancer.
期刊介绍:
The Journal of Visceral Surgery (JVS) is the online-only, English version of the French Journal de Chirurgie Viscérale. The journal focuses on clinical research and continuing education, and publishes original and review articles related to general surgery, as well as press reviews of recently published major international works. High-quality illustrations of surgical techniques, images and videos serve as support for clinical evaluation and practice optimization.
JVS is indexed in the main international databases (including Medline) and is accessible worldwide through ScienceDirect and ClinicalKey.