Functional outcomes after laparoscopic versus robotic-assisted rectal resection: a systematic review and meta-analysis.
Adult
Aged
Aged, 80 and over
Databases, Factual
Female
Humans
Laparoscopy
/ adverse effects
Male
Middle Aged
Odds Ratio
Postoperative Complications
Proctectomy
/ adverse effects
Quality of Life
Rectal Neoplasms
/ surgery
Rectum
/ surgery
Robotic Surgical Procedures
/ adverse effects
Treatment Outcome
Evidence-based medicine
Functional outcomes
Laparoscopy
Meta-analysis
Minimally invasive surgery
Rectal cancer
Robotic-assisted surgery
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
11
09
2019
accepted:
24
12
2019
pubmed:
7
2
2020
medline:
22
6
2021
entrez:
7
2
2020
Statut:
ppublish
Résumé
Surgical resection is crucial for curative treatment of rectal cancer. Through multidisciplinary treatment, including radiochemotherapy and total mesorectal excision, survival has improved substantially. Consequently, more patients have to deal with side effects of treatment. The most recently introduced surgical technique is robotic-assisted surgery (RAS) which seems equally effective in terms of oncological control compared to laparoscopy. However, RAS enables further advantages which maximize the precision of surgery, thus providing better functional outcomes such as sexual function or contience without compromising oncological results. This review was done according to the PRISMA and AMSTAR-II guidelines and registered with PROSPERO (CRD42018104519). The search was planned with PICO criteria and conducted on Medline, Web of Science and CENTRAL. All screening steps were performed by two independent reviewers. Inclusion criteria were original, comparative studies for laparoscopy vs. RAS for rectal cancer and reporting of functional outcomes. Quality was assessed with the Newcastle-Ottawa scale. The search retrieved 9703 hits, of which 51 studies with 24,319 patients were included. There was a lower rate of urinary retention (non-RCTs: Odds ratio (OR) [95% Confidence Interval (CI)] 0.65 [0.46, 0.92]; RCTs: OR[CI] 1.29[0.08, 21.47]), ileus (non-RCTs: OR[CI] 0.86[0.75, 0.98]; RCTs: OR[CI] 0.80[0.33, 1.93]), less urinary symptoms (non-RCTs mean difference (MD) [CI] - 0.60 [- 1.17, - 0.03]; RCTs: - 1.37 [- 4.18, 1.44]), and higher quality of life for RAS (only non-RCTs: MD[CI]: 2.99 [2.02, 3.95]). No significant differences were found for sexual function (non-RCTs: standardized MD[CI]: 0.46[- 0.13, 1.04]; RCTs: SMD[CI]: 0.09[- 0.14, 0.31]). The current meta-analysis suggests potential benefits for RAS over laparoscopy in terms of functional outcomes after rectal cancer resection. The current evidence is limited due to non-randomized controlled trials and reporting of functional outcomes as secondary endpoints.
Identifiants
pubmed: 32025924
doi: 10.1007/s00464-019-07361-1
pii: 10.1007/s00464-019-07361-1
pmc: PMC7746565
doi:
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
81-95Références
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