Meta-analysis and trial sequential analysis of robotic versus laparoscopic total mesorectal excision in management of rectal cancer.

Anastomotic Leak / etiology Humans Laparoscopy Rectal Neoplasms / surgery Robotic Surgical Procedures / adverse effects Treatment Outcome
Laparoscopic Rectal cancer Robotic Total mesorectal excision

Journal

International journal of colorectal disease
ISSN: 1432-1262
Titre abrégé: Int J Colorectal Dis
Pays: Germany
ID NLM: 8607899

Informations de publication

Date de publication:
Aug 2020
Historique:
accepted: 25 05 2020
pubmed: 20 6 2020
medline: 24 6 2021
entrez: 20 6 2020
Statut: ppublish

Résumé

We aimed to evaluate comparative outcomes of robotic and laparoscopic total mesorectal excision (TME) in patients with rectal cancer. We systematically searched electronic data sources with application of combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators, and limits. Perioperative clinical and short-term oncological outcomes were evaluated. Trial Sequential Analysis of the outcomes was conducted. Nine randomised-controlled trials reporting 1463 patients evaluating outcomes of robotic TME (n = 728) and laparoscopic TME (n = 735) were included. Although the robotic approach was associated with significantly longer operative time (MD 31.64, P = 0.002), it was associated with significantly longer DRM (MD 0.8, P = 0.004) and shorter time to soft diet (MD - 0.50, P = 0.03) compared to the laparoscopic approach. Moreover, there was no significant difference in intraoperative (RR 1.07, P = 0.76)) and postoperative (RR 0.97, P = 0.81) complications, anastomotic leak (RR 0.93, P = 0.69), conversion to open rate (RR 0.46, P = 0.05), blood loss (MD 19.65, P = 0.74), time to first flatus (MD - 0.30, P = 0.37), LARS (RR 0.83, P = 0.41), ileus (RR 0.72, P = 0.39), positive CRM (RR 0.82, P = 0.49), PRM (MD - 0.5, P = 0.55), number of harvested lymph nodes (MD 0.33, P = 0.58), or length of stay (MD - 0.60, P = 0.12) between two groups. The Trial Sequential Analysis demonstrated that the risk of type 1 and type 2 errors was minimal in most outcomes. Moderate-quality evidence suggested that robotic and laparoscopic TME may be comparable in terms of clinical and short-term oncological profile but the robotic approach may be associated with longer procedure time. Future high-quality randomised studies are encouraged to compare the functional, long-term oncological, and cost-effectiveness outcomes of both approaches.

Sections du résumé

BACKGROUND BACKGROUND
We aimed to evaluate comparative outcomes of robotic and laparoscopic total mesorectal excision (TME) in patients with rectal cancer.
METHODS METHODS
We systematically searched electronic data sources with application of combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators, and limits. Perioperative clinical and short-term oncological outcomes were evaluated. Trial Sequential Analysis of the outcomes was conducted.
RESULTS RESULTS
Nine randomised-controlled trials reporting 1463 patients evaluating outcomes of robotic TME (n = 728) and laparoscopic TME (n = 735) were included. Although the robotic approach was associated with significantly longer operative time (MD 31.64, P = 0.002), it was associated with significantly longer DRM (MD 0.8, P = 0.004) and shorter time to soft diet (MD - 0.50, P = 0.03) compared to the laparoscopic approach. Moreover, there was no significant difference in intraoperative (RR 1.07, P = 0.76)) and postoperative (RR 0.97, P = 0.81) complications, anastomotic leak (RR 0.93, P = 0.69), conversion to open rate (RR 0.46, P = 0.05), blood loss (MD 19.65, P = 0.74), time to first flatus (MD - 0.30, P = 0.37), LARS (RR 0.83, P = 0.41), ileus (RR 0.72, P = 0.39), positive CRM (RR 0.82, P = 0.49), PRM (MD - 0.5, P = 0.55), number of harvested lymph nodes (MD 0.33, P = 0.58), or length of stay (MD - 0.60, P = 0.12) between two groups. The Trial Sequential Analysis demonstrated that the risk of type 1 and type 2 errors was minimal in most outcomes.
CONCLUSIONS CONCLUSIONS
Moderate-quality evidence suggested that robotic and laparoscopic TME may be comparable in terms of clinical and short-term oncological profile but the robotic approach may be associated with longer procedure time. Future high-quality randomised studies are encouraged to compare the functional, long-term oncological, and cost-effectiveness outcomes of both approaches.

Identifiants

DOI: 10.1007/s00384-020-03655-2 PMID: 32556460
pubmed: 32556460
doi: 10.1007/s00384-020-03655-2
pii: 10.1007/s00384-020-03655-2
doi:

Types de publication

Journal Article Meta-Analysis Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1423-1438

Auteurs

Mokhtar Eltair (M)

Department of Colorectal Surgery, Ealing Hospital, North West London Hospitals NHS Trust, London, UK. mokhtair@hotmail.com.
ORCID: 0000-0001-7132-8757

Shahin Hajibandeh (S)

Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.

Shahab Hajibandeh (S)

Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, UK.

Abdirahaman Nuno (A)

Department of Colorectal Surgery, Ealing Hospital, North West London Hospitals NHS Trust, London, UK.

Kadhim Hussein Abdullah (KH)

Department of Colorectal Surgery, Ealing Hospital, North West London Hospitals NHS Trust, London, UK.

Ahmad Alkaili-Alyamani (A)

Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.

Muhammad Imran Aslam (MI)

Department of Colorectal Surgery, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwickshire, UK.

Ashish Sinha (A)

Department of Colorectal Surgery, Ealing Hospital, North West London Hospitals NHS Trust, London, UK.

Tushar Agarwal (T)

Department of Colorectal Surgery, Ealing Hospital, North West London Hospitals NHS Trust, London, UK.

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Classifications MeSH

questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Désunion anastomotique › Meta-analysis and trial sequential analysis of...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Meta-analysis and trial sequential analysis of...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Endoscopie › Laparoscopie › Meta-analysis and trial sequential analysis of...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies du rectum › Tumeurs colorectales › Tumeurs du rectum › Meta-analysis and trial sequential analysis of...
questionsmedicales.fr › Technologie, industrie et agriculture › Technologie › Automatisation › Interventions chirurgicales robotisées › Meta-analysis and trial sequential analysis of...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Meta-analysis and trial sequential analysis of...