Karem Slim , Gilles Tilmans , Bob Valéry Occéan , Chadly Dziri , Bruno Pereira , Michel Canis
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Data were extracted independently by two reviewers. The risk of bias was analyzed according to the Cochrane Handbook method and the certainty of the evidence according to the GRADE method. The analysis was carried out with R software Version 4.2-3 using the Package for Meta-Analysis “meta” version 6.5-0.</p></div><div><h3>Results</h3><p>Eight randomized trials were included (with a total of 2342 patients), including four that focused specifically on mid-low rectal cancer (<em>n</em> <!-->=<!--> <!-->1,734 patients). No statistically significant difference was found for overall morbidity, intra-operative morbidity, anastomotic leakage, post-operative mortality, quality of mesorectal specimen, and resection margins. The main differences identified were a lower conversion rate for RS (RR<!--> <!-->=<!--> <!-->0.48 [0.24–0.95], <em>p<!--> </em>=<!--> <!-->0.04, I<sup>2</sup> <!-->=<!--> <!-->0%), and a longer operative time for RS (mean difference<!--> <!-->=<!--> <!-->39.11<!--> <!-->min [9.39–68.83], <em>p</em> <!--><<!--> <!-->0.01, I<sup>2</sup> <!-->=<!--> <!-->96%). The other differences had no real clinical relevance, i.e., resumption of flatus passage (5<!--> <!-->hours earlier after RS), and lymph node dissection (one more lymph node for LS).</p></div><div><h3>Conclusion</h3><p>This meta-analysis does not confirm the initial hypothesis and does not show a statistically significant or clinically relevant benefit of RS compared to LS for mid-low rectal cancer.</p></div>","PeriodicalId":2,"journal":{"name":"ACS Applied Bio Materials","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Meta-analysis of randomized clinical trials comparing robotic versus laparoscopic surgery for mid-low rectal cancers\",\"authors\":\"Karem Slim , Gilles Tilmans , Bob Valéry Occéan , Chadly Dziri , Bruno Pereira , Michel Canis\",\"doi\":\"10.1016/j.jviscsurg.2024.01.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Robotic surgery (RS) is experiencing major development, particularly in the context of rectal cancer. 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The analysis was carried out with R software Version 4.2-3 using the Package for Meta-Analysis “meta” version 6.5-0.</p></div><div><h3>Results</h3><p>Eight randomized trials were included (with a total of 2342 patients), including four that focused specifically on mid-low rectal cancer (<em>n</em> <!-->=<!--> <!-->1,734 patients). No statistically significant difference was found for overall morbidity, intra-operative morbidity, anastomotic leakage, post-operative mortality, quality of mesorectal specimen, and resection margins. The main differences identified were a lower conversion rate for RS (RR<!--> <!-->=<!--> <!-->0.48 [0.24–0.95], <em>p<!--> </em>=<!--> <!-->0.04, I<sup>2</sup> <!-->=<!--> <!-->0%), and a longer operative time for RS (mean difference<!--> <!-->=<!--> <!-->39.11<!--> <!-->min [9.39–68.83], <em>p</em> <!--><<!--> <!-->0.01, I<sup>2</sup> <!-->=<!--> <!-->96%). 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引用次数: 0
摘要
简介：机器人手术（RS）正在经历重大发展，尤其是在直肠癌方面：机器人手术（RS）正在经历重大发展，尤其是在直肠癌方面。本荟萃分析旨在总结文献数据，特别关注机器人手术在中低位直肠癌中的安全性和有效性，其假设是机器人手术能在这一解剖位置找到最合理的适应症：荟萃分析根据 PRISMA 2000 建议进行，包括在 Medline-PICO、Cochrane 数据库、Scopus 和 Google 数据库中找到的所有比较机器人手术与腹腔镜手术（LS）的随机试验。数据由两名审稿人独立提取。根据《Cochrane手册》方法分析偏倚风险，根据GRADE方法分析证据的确定性。分析采用 R 软件 4.2-3 版，使用 Meta 分析软件包 "meta "6.5-0 版：共纳入 8 项随机试验（共 2342 名患者），其中 4 项试验专门针对中低位直肠癌（n=1734 名患者）。在总发病率、术中发病率、吻合口漏、术后死亡率、直肠间质标本质量和切除边缘方面，均未发现有统计学意义的差异。发现的主要差异是 RS 的转换率较低（RR=0.48 [0.24-0.95]，P=0.04，I2=0%），RS 的手术时间较长（平均差异=39.11 分钟 [9.39-68.83]，P2=96%）。其他差异与临床无关，即恢复排便（RS术后提前5小时）和淋巴结清扫（LS术后多一个淋巴结）：这项荟萃分析没有证实最初的假设，也没有显示 RS 与 LS 相比对中低位直肠癌有统计学意义或临床相关的益处。
Meta-analysis of randomized clinical trials comparing robotic versus laparoscopic surgery for mid-low rectal cancers
Introduction
Robotic surgery (RS) is experiencing major development, particularly in the context of rectal cancer. The aim of this meta-analysis was to summarize data from the literature, focusing specifically on the safety and effectiveness of robotic surgery in mid-low rectal cancers, based on the hypothesis that that robotic surgery can find its most rational indication in this anatomical location.
Method
The meta-analysis was conducted according to the PRISMA 2000 recommendations, including all randomized trials that compared robotic surgery versus laparoscopic surgery (LS) that were found in the Medline-PICO, Cochrane Database, Scopus and Google databases. Data were extracted independently by two reviewers. The risk of bias was analyzed according to the Cochrane Handbook method and the certainty of the evidence according to the GRADE method. The analysis was carried out with R software Version 4.2-3 using the Package for Meta-Analysis “meta” version 6.5-0.
Results
Eight randomized trials were included (with a total of 2342 patients), including four that focused specifically on mid-low rectal cancer (n = 1,734 patients). No statistically significant difference was found for overall morbidity, intra-operative morbidity, anastomotic leakage, post-operative mortality, quality of mesorectal specimen, and resection margins. The main differences identified were a lower conversion rate for RS (RR = 0.48 [0.24–0.95], p = 0.04, I2 = 0%), and a longer operative time for RS (mean difference = 39.11 min [9.39–68.83], p < 0.01, I2 = 96%). The other differences had no real clinical relevance, i.e., resumption of flatus passage (5 hours earlier after RS), and lymph node dissection (one more lymph node for LS).
Conclusion
This meta-analysis does not confirm the initial hypothesis and does not show a statistically significant or clinically relevant benefit of RS compared to LS for mid-low rectal cancer.
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