The COMPARE Study: Comparing Perioperative Outcomes of Oncologic Minimally Invasive Laparoscopic, Da Vinci Robotic, and Open Procedures: A Systematic Review and meta-analysis of The Evidence.

IF 7.5 1区医学 Q1 SURGERY

Annals of surgery Pub Date : 2024-10-22 DOI:10.1097/SLA.0000000000006572

Rocco Ricciardi, Usha Seshadri-Kreaden, Ana Yankovsky, Douglas Dahl, Hugh Auchincloss, Neera M Patel, April E Hebert, Valena Wright

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引用次数: 0

Abstract

Objective: To assess 30-day outcomes of da Vinci robotic-assisted (dV-RAS) versus laparoscopic/thoracoscopic (lap/VATS) or open oncologic surgery.

Summary background data: Complex procedures in deep/narrow spaces especially benefit from dV-RAS. Prior procedure-specific comparisons are not generalizable.

Methods: PubMed, Scopus and EMBASE were systematically searched (latest: 11/17/2023) following PRISMA and PROSPERO (Reg#CRD42023466759). Randomized, prospective, and database studies were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effect or random-effects (heterogeneity significant). ROBINS-I/RoB 2 were used to assess bias.

Results: Of 56,314 unique references over 12 years from 22 countries, 230 studies (34 randomized, 74 prospective, 122 database) comparing dV-RAS to lap/VATS or open surgery across 7 procedures, 4 specialties, representing 1,194,559 dV-RAS; 1,095,936 lap/VATS and 1,625,320 open cases were included. Operative time for dV-RAS was longer than lap/VATS (MD:17.73min [9.80,25.67], P <0.01) and open surgery (MD:40.92min [28.83,53.00], P <0.01), whereas hospital stay was shorter (lap/VATS MD:-0.51d [-0.64,-0.38], P <0.01; open MD:-1.85d [-2.09,-1.62], P <0.01) and blood loss was less versus open (MD:-293.44ml [-359.53,-227.35]). There were fewer dV-RAS conversions (OR:0.44 [0.40,0.49], P <0.01), transfusions (OR:0.79 [0.72,0.88], P <0.01), postoperative complications (OR:0.90 [0.84,0.96], P <0.01), readmissions (OR:0.91 [0.83,0.99], P =0.04), and deaths (OR:0.86 [0.81,0.92], P <0.01) versus lap/VATS, and fewer transfusions (OR:0.25 [0.21,0.30], P <0.01), postoperative complications (OR:0.56 [0.52,0.61], P <0.01), readmissions (OR:0.71 [0.63,0.81], P <0.01), reoperations (OR:0.89 [0.81,0.97], P <0.01), and deaths (OR:0.54 [0.47,0.63], P <0.01) versus open surgery. Blood loss (MD:-12.26mL [-29.44,4.91], P =0.16) and reoperations (OR:1.03 [0.95,1.11], P =0.48) were similar for dV-RAS and lap/VATS. There was significant heterogeneity.

Conclusions: Da Vinci -RAS confers benefits across oncological procedures and study designs. These results provide clinical evidence to multi-specialty-care decision-makers considering dV-RAS.

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COMPARE 研究：比较肿瘤微创腹腔镜手术、达芬奇机器人手术和开放手术的围手术期效果：证据的系统回顾和荟萃分析》。

目的评估达芬奇机器人辅助（dV-RAS）与腹腔镜/胸腔镜（lap/VATS）或开腹肿瘤手术的30天疗效：深/窄空间的复杂手术尤其受益于dV-RAS。之前针对特定手术的比较不具有普遍性：方法：按照 PRISMA 和 PROSPERO (Reg#CRD42023466759)，对 PubMed、Scopus 和 EMBASE 进行了系统检索（最新时间：2023 年 11 月 17 日）。采用固定效应或随机效应（异质性显著）对随机研究、前瞻性研究和数据库研究以 R 的几率比（OR）或平均差（MD）进行汇总。使用 ROBINS-I/RoB 2 评估偏倚：在22个国家12年中的56314个唯一参考文献中，有230项研究（34项随机研究、74项前瞻性研究、122项数据库研究）比较了dV-RAS与腹腔镜/VATS或开腹手术，涉及7种手术、4个专科，代表了1,194,559例dV-RAS；1,095,936例腹腔镜/VATS和1,625,320例开腹手术。达芬奇-RAS的手术时间长于腹腔/VATS（MD:17.73min [9.80,25.67]，PC结论：达芬奇-RAS在各种肿瘤手术和研究设计中都具有优势。这些结果为考虑采用达芬奇-RAS的多专科决策者提供了临床证据。

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

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.