Robotic Versus Laparoscopic Minimally Invasive Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials
- PMID:28984644
- DOI: 10.1097/SLA.0000000000002523
Robotic Versus Laparoscopic Minimally Invasive Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Abstract
Objective: The aim of this study was to evaluate the safety and efficacy of elective rectal resection for rectal cancer in adults by robotic surgery compared with conventional laparoscopic surgery.
Summary of background data: Technological advantages of robotic surgery favor precise dissection in narrow spaces. However, the evidence base driving recommendations for the use of robotic surgery in rectal cancer primarily hinges on observational data.
Methods: We searched MEDLINE, Embase, and CENTRAL for randomized controlled trials (until August 2016) comparing robotic surgery versus conventional laparoscopic surgery. Data on the following endpoints were evaluated: circumferential margin status, mesorectal grade, number of lymph nodes harvested, rate of conversion to open surgery, postoperative complications, and operative time. Data were summarized as relative risks (RR) or weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). Risk of bias of studies was assessed with standard methods.
Results: Five trials were eligible, including 334 robotic and 337 laparoscopic surgery cases. Meta-analysis showed that RS was associated with lower conversion rate (7.3%; 4 studies, 544 participants, RR 0.58; 95% CI 0.35-0.97, P = 0.04, I = 0%) and longer operating time (MD 38.43 minutes, 95% CI 31.84-45.01: P < 0.00001) compared with laparoscopic surgery. Perioperative mortality, rate of circumferential margin involvement (2 studies, 489 participants, RR 0.82, 95% CI 0.39-1.73), and lymph nodes collected (mean 17.4 Lymph Nodes; 5 trials, 674 patients, MD -0.35, 95% CI -1.83 to 1.12) were similar. The quality of the evidence was moderate for most outcomes.
Conclusion: Evidence of moderate quality supports that robotic surgery for rectal cancer produces similar perioperative outcomes of oncologic procedure adequacy to conventional laparoscopic surgery. Robotic surgery portraits lower rate of conversion to open surgery, while operating time is significantly longer than by laparoscopic approach.
Comment in
- Response to Comment on "Robotic Versus Laparoscopic Surgery for Rectal Cancer: An Evidence-based Approach".Prete FP, Prete F, Strippoli GFM.Prete FP, et al.Ann Surg. 2019 Aug;270(2):e57-e58. doi: 10.1097/SLA.0000000000003159.Ann Surg. 2019.PMID:30585819No abstract available.
- Comment on "Robotic Versus Laparoscopic Surgery for Rectal Cancer: An Evidence-based Approach".Simillis C, Tekkis PP.Simillis C, et al.Ann Surg. 2019 Aug;270(2):e57. doi: 10.1097/SLA.0000000000003156.Ann Surg. 2019.PMID:30601259No abstract available.
Similar articles
- There is no difference in outcome between laparoscopic and open surgery for rectal cancer: a systematic review and meta-analysis on short- and long-term oncologic outcomes.Pędziwiatr M, Małczak P, Mizera M, Witowski J, Torbicz G, Major P, Pisarska M, Wysocki M, Budzyński A.Pędziwiatr M, et al.Tech Coloproctol. 2017 Aug;21(8):595-604. doi: 10.1007/s10151-017-1662-4. Epub 2017 Aug 9.Tech Coloproctol. 2017.PMID:28795243Free PMC article.Review.
- Total mesorectal excision for mid and low rectal cancer: Laparoscopic vs robotic surgery.Feroci F, Vannucchi A, Bianchi PP, Cantafio S, Garzi A, Formisano G, Scatizzi M.Feroci F, et al.World J Gastroenterol. 2016 Apr 7;22(13):3602-10. doi: 10.3748/wjg.v22.i13.3602.World J Gastroenterol. 2016.PMID:27053852Free PMC article.
- Open Versus Laparoscopic Versus Robotic Versus Transanal Mesorectal Excision for Rectal Cancer: A Systematic Review and Network Meta-analysis.Simillis C, Lal N, Thoukididou SN, Kontovounisios C, Smith JJ, Hompes R, Adamina M, Tekkis PP.Simillis C, et al.Ann Surg. 2019 Jul;270(1):59-68. doi: 10.1097/SLA.0000000000003227.Ann Surg. 2019.PMID:30720507
- A Pooled Analysis of Robotic Versus Laparoscopic Surgery for Total Mesorectal Excision for Rectal Cancer.Wang Y, Zhao GH, Yang H, Lin J.Wang Y, et al.Surg Laparosc Endosc Percutan Tech. 2016 Jun;26(3):259-64. doi: 10.1097/SLE.0000000000000263.Surg Laparosc Endosc Percutan Tech. 2016.PMID:27213786Review.
- Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis.Lee SH, Kim DH, Lim SW.Lee SH, et al.Int J Colorectal Dis. 2018 Dec;33(12):1741-1753. doi: 10.1007/s00384-018-3145-0. Epub 2018 Sep 5.Int J Colorectal Dis. 2018.PMID:30187156
Cited by
- Robotic-Assisted versus Laparoscopic Left Hemicolectomy-Postoperative Inflammation Status, Short-Term Outcome and Cost Effectiveness.Widder A, Kelm M, Reibetanz J, Wiegering A, Matthes N, Germer CT, Seyfried F, Flemming S.Widder A, et al.Int J Environ Res Public Health. 2022 Aug 25;19(17):10606. doi: 10.3390/ijerph191710606.Int J Environ Res Public Health. 2022.PMID:36078317Free PMC article.
- The Role of Indocyanine Green Fluorescence in Rectal Cancer Robotic Surgery: A Narrative Review.Belloni E, Muttillo EM, Di Saverio S, Gasparrini M, Brescia A, Nigri G.Belloni E, et al.Cancers (Basel). 2022 May 13;14(10):2411. doi: 10.3390/cancers14102411.Cancers (Basel). 2022.PMID:35626015Free PMC article.Review.
- Recent updates in the surgical treatment of colorectal cancer.Matsuda T, Yamashita K, Hasegawa H, Oshikiri T, Hosono M, Higashino N, Yamamoto M, Matsuda Y, Kanaji S, Nakamura T, Suzuki S, Sumi Y, Kakeji Y.Matsuda T, et al.Ann Gastroenterol Surg. 2018 Feb 15;2(2):129-136. doi: 10.1002/ags3.12061. eCollection 2018 Mar.Ann Gastroenterol Surg. 2018.PMID:29863145Free PMC article.Review.
- Surgical outcomes and cost analysis of a multi-specialty robotic-assisted surgery caseload in the Australian public health system.Steffens D, McBride KE, Hirst N, Solomon MJ, Anderson T, Thanigasalam R, Leslie S, Karunaratne S, Bannon PG.Steffens D, et al.J Robot Surg. 2023 Oct;17(5):2237-2245. doi: 10.1007/s11701-023-01643-6. Epub 2023 Jun 8.J Robot Surg. 2023.PMID:37289337Free PMC article.
- Recurrence Risk after Radical Colorectal Cancer Surgery-Less Than before, But How High Is It?Osterman E, Hammarström K, Imam I, Osterlund E, Sjöblom T, Glimelius B.Osterman E, et al.Cancers (Basel). 2020 Nov 9;12(11):3308. doi: 10.3390/cancers12113308.Cancers (Basel). 2020.PMID:33182510Free PMC article.Review.
Publication types
MeSH terms
Related information
LinkOut - more resources
Full Text Sources
Other Literature Sources
Research Materials