Efficacy of robot-assisted vs. laparoscopy surgery in the treatment of colorectal cancer: A systematic review and meta-analysis

Leilei Yang; Chengfeng Fang; Tienan Bi; Jiaju Han; Ruili Zhang; Shenkang Zhou

doi:10.1016/j.clinre.2023.102176

Efficacy of robot-assisted vs. laparoscopy surgery in the treatment of colorectal cancer: A systematic review and meta-analysis

Clin Res Hepatol Gastroenterol. 2023 Aug;47(7):102176. doi: 10.1016/j.clinre.2023.102176. Epub 2023 Jul 15.

Authors

Leilei Yang¹, Chengfeng Fang¹, Tienan Bi¹, Jiaju Han¹, Ruili Zhang², Shenkang Zhou³

Affiliations

¹ Department of Gastrointestinal Surgery, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang, China; Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, China.
² Department of Gastrointestinal Surgery, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang, China; Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, China. Electronic address: zhangrl@enzemed.com.
³ Department of Gastrointestinal Surgery, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang, China; Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, China. Electronic address: tzyywcwk@163.com.

PMID: 37454927
DOI: 10.1016/j.clinre.2023.102176

Abstract

Purpose: To compare the efficacy of robot-assisted colorectal surgery (RACS) vs. laparoscopic-assisted colorectal surgery (LACS) in the treatment of colorectal cancer (CRC).

Methods: PubMed, Embase, and the Cochrane Library databases were systematically searched for randomized controlled trials (RCTs) reporting on RACS and LACS in CRC patients published up to January 4, 2022. The outcomes included operative time, length of stay, conversion, circumferential resection margin positivity (CRM+), and complications.

Results: Six RCTs (412 participants with RACS and 420 with LACS) were included. The pooled results showed shorter operative time (WMD=44.28, 95%CI: 9.36, 79.19, P = 0.013; P_Q<0.001) and lower costs in RACS than in LACS (WMD=1546.15, 95%CI: 761.51, 2330.78, P<0.001; P_Q=0.208), while no differences were observed for the length of stay (WMD=-0.31, 95%CI: -1.13,0.51, P = 0.456; I²=0.0%, P_Q=0.990), blood loss (WMD=-33.72, 95%CI: -205.06, 137.62, P = 0.700; I2=89.0%, P_Q=0.003), the number of harvested lymph nodes (WMD=1.38, 95%CI: -0.09, 2.85, P = 0.066; I²=0.0%, P_Q=0.645), the time of first flatus (WMD=0.20, 95%CI: -0.20, 0.61, P = 0.328; I2=0.0%, P_Q=0.337), rates of conversion to open surgery (RR=0.62, 95%CI: 0.38,1.01, P = 0.053; I²=0.0%, P_Q=0.459), complication rates (RR=1.11, 95%CI: 0.83,1.49, P = 0.466; I²=0.0%, P_Q=0.948), and CRM+ rates (RR=1.02, 95%CI: 0.66,1.58, P = 0.938; I²=0.0%, P_Q=0.408). No publication bias was detected. The sensitivity analyses showed that the results for the operative time were robust.

Conclusions: Patients with CRC who underwent RACS and LACS had a similar length of stay, blood loss, the time of first flatus, rates of conversion to open surgery, the number of harvested lymph nodes, complication rates, and CRM+ rates; however, RACS led to longer surgeries and higher costs than LACS.

Keywords: Colorectal cancer; Laparoscopy; Meta-analysis; Robotic surgical procedures.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Colorectal Neoplasms* / complications
Colorectal Neoplasms* / surgery
Flatulence / complications
Flatulence / surgery
Humans
Laparoscopy* / adverse effects
Length of Stay
Lymph Nodes
Operative Time
Postoperative Complications / etiology
Robotics*
Treatment Outcome