Abstract
ObjectiveRobotic and laparoscopic surgery for rectal cancer has been applied in the clinic for decades; nevertheless, which surgical approach has a lower rate of postoperative complications is still inconclusive. Therefore, the aim of this meta-analysis was to compare the postoperative complications within 30 days between robotic and laparoscopic rectal cancer surgery based on randomized controlled trials.MethodsRandomized controlled trials (until May 2020) that compared robotic and laparoscopic rectal cancer surgery were searched through PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and China Biology Medicine disc (CBMdisc). Data regarding sample size, clinical and demographic characteristics, and postoperative complications within 30 days, including overall postoperative complications, severe postoperative complications (Clavien-Dindo score ≥ III), anastomotic leakage, surgical site infection, bleeding, ileus, urinary complications, respiratory complications, conversion to open surgery, unscheduled reoperation, perioperative mortality, and pathological outcomes, were extracted. The results were analyzed using RevMan v5.3.ResultsSeven randomized controlled trials that included 507 robotic and 516 laparoscopic rectal cancer surgery cases were included. Meta-analysis showed that the overall postoperative complications within 30 days [Z = 1.1, OR = 1.18, 95% CI (0.88–1.57), P = 0.27], severe postoperative complications [Z = 0.22, OR = 1.12, 95% CI (0.41–3.07), P = 0.83], anastomotic leakage [Z = 0.96, OR = 1.27, 95% CI (0.78–2.08), P = 0.34], surgical site infection [Z = 0.18, OR = 1.05, 95% CI (0.61–1.79), P = 0.86], bleeding [Z = 0.19, OR = 0.89, 95% CI (0.27–2.97), P = 0.85], ileus [Z = 1.47, OR = 0.66, 95% CI (0.38–1.15), P = 0.14], urinary complications [Z = 0.66, OR = 1.22, 95% CI (0.67–2.22), P = 0.51], respiratory complications [Z = 0.84, OR = 0.64, 95% CI (0.22–1.82), P = 0.40], conversion to open surgery [Z = 1.73, OR = 0.61, 95% CI (0.35–1.07), P = 0.08], unscheduled reoperation [Z = 0.14, OR = 0.91, 95% CI (0.26–3.20), P = 0.89], perioperative mortality [Z = 0.28, OR = 0.79, 95% CI (0.15–4.12), P = 0.78], and pathological outcomes were similar between robotic and laparoscopic rectal surgery.ConclusionRobotic surgery for rectal cancer was comparable to laparoscopic surgery with respect to postoperative complications within 30 days.
Highlights
IntroductionSince robotic surgery was first used in rectal disease in 2001 [6], robotic surgery has gained great popularity worldwide
Laparoscopic rectal resection has been widely used for the treatment of rectal cancer because it results in a shorter length of hospital stay, less postoperative pain, and faster recovery of bowel function than open surgery [1,2,3]; laparoscopic technology is associated with some innate limitations, such as a two-dimensional view and limited dexterity, which may affect the surgery outcomes [4, 5].Since robotic surgery was first used in rectal disease in 2001 [6], robotic surgery has gained great popularity worldwide
Robotic surgery for rectal cancer was comparable to laparoscopic surgery with respect to postoperative complications within 30 days
Summary
Since robotic surgery was first used in rectal disease in 2001 [6], robotic surgery has gained great popularity worldwide This technique has several advantages over laparoscopic surgery, including an immersive three-dimensional view of the surgical field, better dexterity capability, and a stable camera platform [7]. A number of comparative studies have reported the results between robotic and laparoscopic surgery for rectal cancer, but it is still unclear which surgical approach has a lower rate of postoperative complications [8,9,10]. We conducted this metaanalysis to evaluate the postoperative complications within 30 days between robotic and laparoscopic rectal cancer surgery based only on randomized controlled trials
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