用于机器人辅助根治性前列腺切除术的 DaVinci 和 Hugo™ RAS 机器人平台的正面比较:比较研究的系统回顾和荟萃分析。

IF 5.1 2区 医学 Q1 ONCOLOGY Prostate Cancer and Prostatic Diseases Pub Date : 2024-10-15 DOI:10.1038/s41391-024-00908-x
Francesco Ditonno, Greta Pettenuzzo, Francesca Montanaro, Lorenzo De Bon, Sonia Costantino, Endri Toska, Sarah Malandra, Francesco Cianflone, Alberto Bianchi, Antonio Benito Porcaro, Maria Angela Cerruto, Alessandro Veccia, Riccardo Bertolo, Alessandro Antonelli
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引用次数: 0

摘要

背景:我们对使用达芬奇(DV-RARP)或雨果™RAS(H-RARP)平台的机器人辅助前列腺癌根治术(RARP)的术中和术后效果进行了系统回顾和荟萃分析:该研究在 PROSPERO (CRD42024562326) 上注册,并遵循 PRISMA 指南。2024年6月,利用学术数据库进行了文献检索,重点关注2021年至2024年的文章。研究问题聚焦于接受 H-RARP (I) 与 DV-RARP (C) 治疗的男性 PCa 患者(P),以评估不同比较研究的手术、病理和功能结果(O)。连续变量采用平均差(MD)进行总结,分类变量采用几率比和 95% 置信区间(CI)进行总结。异质性采用 Cochran's Q 检验和 I2 统计量进行评估。发表偏倚采用 Egger 检验和 Begg 检验进行评估。统计分析使用 Stata®17.0 进行,显著性设置为 p 结果:八项研究(三项前瞻性研究,五项回顾性研究)共纳入 1114 名患者(454 名 H-RARP 与 660 名 DV-RARP)。两组患者的基线特征相当。在总体手术时间、控制台时间、失血量、神经保留或淋巴腺切除方面没有发现明显差异。Hugo™RAS的对接时间明显更长(MD:6 min,95% CI 4.2;7.8)。术后结果(包括并发症、住院时间和导管插入时间)相似。病理结果显示,手术切缘阳性率或分期无明显差异,但H-RARP的结节率较低(MD:-2,95% CI -3.3;-0.6)。尿失禁恢复情况相当。偏倚风险为中度至严重:荟萃分析表明,除对接时间和淋巴结产量外,H-RARP和DV-RARP在大多数分析结果上没有统计学差异。Hugo™RAS 的对接时间较长,这表明设置要求较高,但并不意味着手术时间明显延长。虽然在统计学上有意义,但观察到的淋巴结产量差异在临床上可能微不足道。
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Head-to-head comparison of DaVinci and Hugo™ RAS robotic platforms for robot-assisted radical prostatectomy: a systematic review and meta-analysis of comparative studies.

Background: We conducted a systematic review and meta-analysis of comparative studies to analyze intra- and postoperative outcomes of robot-assisted radical prostatectomy (RARP) using either DaVinci (DV-RARP) or Hugo™RAS (H-RARP) platforms.

Methods: The study was registered in PROSPERO (CRD42024562326) and followed PRISMA guidelines. Literature search was conducted in June 2024 using academic databases, focusing on articles from 2021 to 2024. Research question focused on men with PCa (P) undergoing H-RARP (I) versus DV-RARP (C) to evaluate surgical, pathology, and functional outcomes (O), across comparative studies. Continuous variables were summarized using mean difference (MD) and categorical variables using odds ratio with 95% confidence intervals (CI). Heterogeneity was assessed using Cochran's Q test and I2 statistics. Publication bias was evaluated with Egger's and Begg's tests. Statistical analysis was performed with Stata®17.0, with significance set at p < 0.05. Risk of bias was assessed using the ROBINS-I tool. Methodological quality was evaluated with AMSTAR 2.

Results: Eight studies (three prospective, five retrospective) with 1114 patients (454 H-RARP vs. 660 DV-RARP) were included. Baseline characteristics were comparable between groups. No significant differences were found in overall operative time, console time, blood loss, nerve-sparing, or lymphadenectomy. Docking time was significantly longer for Hugo™RAS (MD:6 min,95% CI 4.2;7.8). Postoperative outcomes, including complications, length of stay, and catheterization time, were similar. Pathological outcomes showed no significant differences in positive surgical margins or staging, but lower node yield was observed with H-RARP (MD:-2,95% CI -3.3;-0.6). Urinary continence recovery was comparable. Risk of bias was moderate to serious.

Conclusion: The meta-analysis suggests H-RARP and DV-RARP perform not statistically different across most of analyzed outcomes, except for docking time and lymph-node yield. The longer docking time associated with the Hugo™RAS suggests demanding setup but does not translate into significantly longer operative time. Although statistically significant, the observed difference in lymph-node yield might be clinically negligible.

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来源期刊
Prostate Cancer and Prostatic Diseases
Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学
CiteScore
10.00
自引率
6.20%
发文量
142
审稿时长
6-12 weeks
期刊介绍: Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
期刊最新文献
Focal therapy using high-intensity focused ultrasound with intraoperative prostate compression for patients with localized prostate cancer: a multi-center prospective study with 7 year experience. Combining tissue biomarkers with mpMRI to diagnose clinically significant prostate cancer. Analysis of 21 biomarkers in the PICTURE study. Clinical characteristics and treatment of patients with small cell prostate cancer: analysis of a real-world cohort from an oncology database. Single-port transvesical simple prostatectomy for the surgical treatment of benign prostatic hyperplasia: functional and continence outcomes. MDT perspective: innovative applications of stereotactic body radiation therapy in metastatic castration-resistant prostate cancer.
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