Abstract：
The objective of this meta-analysis was to assess the comparative efficacy of robot-assisted and laparoscopic surgery in treating gastric cancer among patients characterized by a high visceral fat area (VFA). In April 2024, we conducted a comprehensive literature review using major international databases, such as PubMed, Embase, and Google Scholar. We restricted our selection to articles written in English, excluding reviews, protocols without published data, conference abstracts, and irrelevant content. Our analysis focused on continuous data using 95% confidence intervals (CIs) and standard mean differences (SMDs), while dichotomous data were assessed with odds ratios (ORs) and 95% CIs. We set the threshold for statistical significance at P < 0.05. Data extraction included baseline characteristics, primary outcomes (such as operative time, major complications, lymph node yield, and anastomotic leakage), and secondary outcomes. The meta-analysis included three cohort studies totaling 970 patients. The robotic-assisted group demonstrated a significantly longer operative time compared to the laparoscopic group, with a weighted mean difference (WMD) of - 55.76 min (95% CI - 74.03 to - 37.50; P < 0.00001). This group also showed a reduction in major complications, with an odds ratio (OR) of 2.48 (95% CI 1.09-5.66; P = 0.03) and fewer occurrences of abdominal infections (OR 3.17, 95% CI 1.41-7.14; P = 0.005), abdominal abscesses (OR 3.83, 95% CI 1.53-9.57; P = 0.004), anastomotic leaks (OR 4.09, 95% CI 1.73-9.65; P = 0.001), and pancreatic leaks (OR 8.93, 95% CI 2.33-34.13; P = 0.001). However, no significant differences were observed between the groups regarding length of hospital stay, overall complications, estimated blood loss, or lymph node yield. Based on our findings, robot-assisted gastric cancer surgery in obese patients with visceral fat appears to be correlated with fewer major complications compared to laparoscopic surgery, while maintaining similar outcomes in other surgical aspects. However, it is important to note that robot-assisted procedures do tend to have longer operative times.
摘要：
这项荟萃分析的目的是评估机器人辅助和腹腔镜手术在高内脏脂肪面积（VFA）患者中治疗胃癌的比较疗效。2024年4月，我们利用主要的国际数据库进行了全面的文献综述，比如PubMed,Embase,谷歌学者。我们的选择仅限于用英语写的文章，不包括评论，没有公布数据的协议，会议摘要，和不相关的内容。我们的分析集中在使用95%置信区间(CI)和标准平均差(SMD)的连续数据上，而二分法数据用比值比(OR)和95%CI进行评估。我们将统计学意义的阈值设置为P<0.05。数据提取包括基线特征，主要结果(如手术时间，主要并发症,淋巴结产量，和吻合口漏)，和次要结果。荟萃分析包括三项队列研究，共970例患者。与腹腔镜组相比，机器人辅助组的手术时间明显更长，加权平均差（WMD）为-55.76min（95%CI-74.03至-37.50；P<0.00001）。该组还显示主要并发症的减少，比值比（OR）为2.48（95％CI1.09-5.66；P=0.03），腹部感染发生率较低（OR3.17，95％CI1.41-7.14；P=0.005），腹部脓肿（OR3.83，95%CI1.53-9.57；P=0.004），吻合口瘘（OR4.09，95％CI1.73-9.65；P=0.001），和胰漏（OR8.93，95%CI2.33-34.13；P=0.001）。然而,两组在住院时间方面没有观察到显著差异，整体并发症,估计失血量,或淋巴结产量。根据我们的发现,与腹腔镜手术相比，机器人辅助的胃癌手术治疗肥胖患者内脏脂肪似乎与较少的主要并发症相关，在其他手术方面保持相似的结果。然而,重要的是要注意，机器人辅助程序往往有更长的手术时间。
