Clinical, pathological, and oncologic outcomes of robotic-assisted versus laparoscopic proctectomy for rectal cancer: A meta-analysis of randomized controlled studies

Abstract

Although several meta-analyses regarding robot-assisted proctectomy (RP) and laparoscopic proctectomy (LP) in patients with rectal cancer are constantly being published, meta-analyses considering randomized controlled trials (RCTs) are still rare. It is therefore necessary to conduct an appropriate meta-analysis to provide reliable evidence for clinical decision-making. Databases such as PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials (CCTR) and Cochrane Database of Systematic Reviews (CDSR) were used to collect RCTs assessing the effectiveness and safety of RP and LP. Article search was performed until August 2019. Data were extracted and the quality was evaluated by two reviewers independently, according to the inclusion and exclusion criteria. Data were analyzed using R software. Eight RCTs were included involving 999 patients, 495 of them underwent RP and 504 underwent LP. The results showed that the RP group had a longer operative time (P < 0.01), a lower conversion rate (P = 0.03), a longer distance to the distal margin (DDM) (P = 0.001), and a lower incidence of erectile dysfunction (P = 0.02). No significant differences were found in perioperative mortality, complication rates, PRM, number of harvested lymph nodes, length of hospital stay and time to first bowel movement between the two groups. Current evidence suggests that RP is superior to LP in short-term clinical outcomes, which is similar to LP regarding pathological outcomes and has better DDM outcomes. However, the comparison between RP and LP regarding long-term oncology outcomes still require further multi-center and large RCT samples to confirm our evidences.

Keywords: Laparoscopic proctectomy; Meta-analysis; Randomized controlled trials; Rectal cancer; Robotic-assisted proctectomy.