Abstract
BackgroundWe intended to compare the clinical effect of robotic surgery with laparoscopy and laparotomy in ovarian cancer treatment.MethodsThe included studies were retrieved from PubMed, Embase, and the Cochrane Library databases. The Methodological Index for Nonrandomized Studies (MINORS) was used to evaluate the study quality. Effect measures were presented with weighted mean difference (WMD)/odds ratio (OR) and 95% confidence interval (CI), and heterogeneity test was assessed using Q test and I2 statistics to determine the use of the random effects model or fixed effects model. Egger’s test was used to assess the publication bias.ResultsA total of eight studies was included in this meta-analysis with a MINORS score of 16–18. In the random effects model, estimated blood loss (EBL) of robotic surgery was significantly less compared with laparotomy (WMD = − 521.7027, 95% CI − 809.7816; − 233.6238). In the fixed effects model, length of hospital stay (LHS) (WMD = − 5.2225, 95% CI − 6.1485; − 4.2965) and postoperative complication (PC) (OR = 0.4710, 95% CI 0.2537; 0.8747) of robotic surgery were significantly less, and overall survival (OS) rate (OR = 6.4355, 95% CI 1.6722; 24.7678, P = 0.0070) of robotic surgery was significantly higher compared with laparotomy. There was no difference in the effect size of all variables between robotic surgery and laparoscopy. Meanwhile, a publication bias (t = 6.8290, P = 0.002405) was only identified for PC in robotic surgery and laparotomy groups; no publication bias was identified for the other variables.ConclusionsDespite the above results, it failed to show oncological safety and recurrence by pathological stages or histologic types in this meta-analysis, and those confounding factors might affect the clinical outcome. Future meta-analyses with a larger number of eligible randomized controlled trial studies were needed to determine the most suitable treatment method for patients with different stages and types of ovarian cancer.
Highlights
We intended to compare the clinical effect of robotic surgery with laparoscopy and laparotomy in ovarian cancer treatment
The literatures were selected with the following criteria: all the patients were women with ovarian cancer; the studies contained the robotic surgery group and the control group, and the outcomes included overall survival (OS) rate, disease-free survival (DFS) rate, estimated blood loss (EBL)/ml, length of hospital stay (LHS)/days, operating time (OT)/min, postoperative complication (PC), pelvic nodes (PN), and postoperative recurrence (PR) or included at least one of them; the patients with or without neoadjuvant chemotherapy were all included; the types and language for the studies had no restriction
Study retrieval In all, 139 studies were retrieved from the PubMed, Embase, and Cochrane library databases based on the predefined search strategy, and 23 studies were retained after removal of 43 repeated studies, 10 reviews, 11 conference reports, 21 case reports/series, 17 non-human studies, and 14 irrelevant studies
Summary
We intended to compare the clinical effect of robotic surgery with laparoscopy and laparotomy in ovarian cancer treatment. The early diagnosis of ovarian cancer is extremely difficult due to locating deep in the pelvic cavity and lacking of typical symptoms, and most patients are preliminarily diagnosed as advanced stage with a bad prognosis and 5-year survival rate [2]. The basic treatment of ovarian cancer is still the. Laparoscopy provides an intuitive examination into the pelvic and abdominal organs, which is as effective as traditional laparotomy for the diagnosis of ovarian cancer with avoiding unnecessary laparotomy [5, 6]. Laparoscopy provides multiple advantages in the treatment of early ovarian cancer, such as minimal abdominal incision and a decrease of recovery time. There remain some disadvantages for laparoscopy in the treatment of early ovarian cancer, including preventing palpation of lymph nodes and existing a possible risk of trocar site metastasis [8]
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