Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis

Yanlai Sun, Huirong Xu, Zengjun Li, Jianjun Han, Wentao Song, Junwei Wang, Zhongfa Xu, Yanlai Sun, Huirong Xu, Zengjun Li, Jianjun Han, Wentao Song, Junwei Wang, Zhongfa Xu

Abstract

Background: The objective of this meta-analysis was to compare the clinical and oncologic outcomes of robotic low anterior resection (R-LAR) with conventional laparoscopic low anterior resection (L-LAR).

Methods: A search in the MEDLINE, Embase, and Ovid databases was performed for studies published before July 2014 that compared the clinical and oncologic outcomes of R-LAR and L-LAR. The methodological quality of the selected studies was assessed. Depending on statistical heterogeneity, a fixed or random effects model was used for the meta-analysis. The clinical and oncologic outcomes evaluated included operative time, estimated blood loss, length of hospital stay, rate of conversion to open surgery, post-operative complications, circumferential margin status, and number of lymph nodes collected.

Results: Eight studies, including 324 R-LAR cases and 268 conventional L-LAR cases, were analyzed. The meta-analysis showed that R-LAR was associated with a shorter hospital stay (mean difference (MD) = -1.03; 95% confidence interval (CI) = -1.78, -0.28; P = 0.007), lower conversion rate (odds ratio (OR) = 0.08; 95% CI = 0.02, 0.31; P = 0.0002), lower rate of circumferential margin involvement (OR = 0.5; 95% CI = 0.25, 1.01; P = 0.05), and lower overall complication rate (MD = 0.65; 95% CI = 0.43, 0.99; P = 0.04) compared with L-LAR. There was no difference in operative time (MD = 28.4; 95% CI = -3.48, 60.27; P = 0.08), the number of lymph nodes removed (MD = -0.63; 95% CI = -0.78, 2.05; P = 0.38), and days to return of bowel function (MD = -0.15; 95% CI = -0.37, 0.06; P = 0.17).

Conclusions: R-LAR was shown to be associated with a shorter hospital stay, lower conversion rate, lower rate of circumferential margin involvement, and lower overall complication rate compared with L-LAR. There were no differences in operative time, the number of lymph nodes removed, and days to return of bowel function.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection for meta-analysis
Fig. 2
Fig. 2
Robotic compared with laparoscopic low anterior resection for cancer: operative time
Fig. 3
Fig. 3
Robotic compared with laparoscopic low anterior resection for cancer: length of hospital stay
Fig. 4
Fig. 4
Robotic compared with laparoscopic low anterior resection for cancer: length of hospital stay
Fig. 5
Fig. 5
Robotic compared with laparoscopic low anterior resection for cancer: number of harvested lymph nodes
Fig. 6
Fig. 6
Robotic compared with laparoscopic low anterior resection for cancer: positive circumferential resection margin involvement
Fig. 7
Fig. 7
Robotic compared with laparoscopic low anterior resection for cancer: post-operative overall complications
Fig. 8
Fig. 8
Robotic compared with laparoscopic low anterior resection for cancer: days to return of bowel function

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Source: PubMed

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