Robotic versus laparoscopic surgery for colorectal disease: a systematic review, meta-analysis and meta-regression of randomised controlled trials.

IF 1.1 4区 医学 Q3 SURGERY Annals of the Royal College of Surgeons of England Pub Date : 2024-11-01 Epub Date: 2024-05-24 DOI:10.1308/rcsann.2024.0038
A Thrikandiyur, G Kourounis, S Tingle, P Thambi
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Abstract

Introduction: Robotic surgery (RS) is gaining prominence in colorectal procedures owing to advantages like three-dimensional vision and enhanced dexterity, particularly in rectal surgery. Although recent reviews report similar outcomes between laparoscopic surgery (LS) and RS, this study investigates the evolving trends in outcomes over time, paralleling the increasing experience in RS.

Methods: A systematic review, meta-analysis and meta-regression were conducted of randomised controlled trials exploring postoperative outcomes in patients undergoing RS or LS for colorectal pathology. The primary outcome measure was postoperative complications. Risk of bias was evaluated using the Cochrane Collaboration's assessment tool. Randomised controlled trials were identified from the PubMed®, Embase® and CINAHL® (Cumulative Index to Nursing and Allied Health Literature) databases via the Cochrane Central Register of Controlled Trials.

Results: Of 491 articles screened, 13 fulfilled the inclusion criteria. Meta-analysis of postoperative complications revealed no significant difference between RS and LS (relative risk [RR]: 0.96, 95% confidence interval [CI]: 0.79 to 1.18, p=0.72). Meta-regression analysis of postoperative complications demonstrated a significant trend favouring RS over time (yearly change in Ln(RR): -0.0620, 95% CI: -0.1057 to -0.0183, p=0.005). Secondary outcome measures included operative time, length of stay, blood loss, conversion to open surgery, positive circumferential resection margins and lymph nodes retrieved. The only significant findings were shorter operative time favouring LS (mean difference: 41.48 minutes, 95% CI: 22.15 to 60.81 minutes, p<0.001) and fewer conversions favouring RS (RR: 0.57, 95% CI: 0.37 to 0.85, p=0.007).

Conclusions: As experience in RS grows, evidence suggests an increasing safety profile for patients. Meta-regression revealed a significant temporal trend with complication rates favouring RS over LS. Heterogeneous reporting of complications hindered subgroup analysis of minor and major complications. LS remains quicker. Rising adoption of RS coupled with emerging evidence is expected to further elucidate its clinical efficacy.

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机器人与腹腔镜手术治疗结直肠疾病:随机对照试验的系统综述、荟萃分析和荟萃回归。
导言:由于机器人手术(RS)具有三维视觉和灵巧性增强等优势,在结直肠手术中的地位日益突出,尤其是在直肠手术中。尽管最近的综述报告显示腹腔镜手术(LS)和机器人手术的疗效相似,但本研究调查了随着时间推移疗效的变化趋势,这与机器人手术的经验不断增加是一致的:方法:本研究对随机对照试验进行了系统回顾、荟萃分析和荟萃回归,探讨了因结肠直肠病变而接受RS或LS手术的患者的术后效果。主要结果指标为术后并发症。使用 Cochrane 协作组织的评估工具对偏倚风险进行了评估。随机对照试验是通过 Cochrane 对照试验中央登记册从 PubMed®、Embase® 和 CINAHL®(护理与联合健康文献累积索引)数据库中进行鉴定的:结果:在筛选出的 491 篇文章中,有 13 篇符合纳入标准。术后并发症的 Meta 分析显示,RS 和 LS 之间没有显著差异(相对风险 [RR]: 0.96,95% 置信区间):0.96,95% 置信区间 [CI]:0.79至1.18,P=0.72)。术后并发症的元回归分析表明,随着时间的推移,RS有明显的优势(Ln(RR)的年变化:-0.0620,95% CI:-0.1057 至 -0.0183,P=0.005)。次要结局指标包括手术时间、住院时间、失血量、转为开放手术、环切缘阳性和淋巴结取材。唯一有意义的发现是LS的手术时间更短(平均差异:41.48分钟,95% CI:22.15-60.81分钟,pp=0.007):随着RS经验的增加,有证据表明患者的安全性越来越高。元回归显示,并发症发生率呈显著的时间趋势,RS优于LS。并发症报告的不一致性阻碍了对轻微和严重并发症的分组分析。LS仍然更快。RS的采用率不断上升,加上新出现的证据,有望进一步阐明其临床疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.40
自引率
0.00%
发文量
316
期刊介绍: The Annals of The Royal College of Surgeons of England is the official scholarly research journal of the Royal College of Surgeons and is published eight times a year in January, February, March, April, May, July, September and November. The main aim of the journal is to publish high-quality, peer-reviewed papers that relate to all branches of surgery. The Annals also includes letters and comments, a regular technical section, controversial topics, CORESS feedback and book reviews. The editorial board is composed of experts from all the surgical specialties.
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