Abstract：
BACKGROUND: A meta-analysis was conducted on the perioperative and oncological outcomes of robot-assisted and laparoscopic lateral lymph node dissection in rectal cancer. There are few articles and reports on this topic, and a lack of high-quality research results in unreliable research conclusions. This study includes prospective and retrospective studies to obtain more reliable findings.
METHODS: Databases were searched, including PubMed, EMBASE, Cochrane, and Web of Science. The search was conducted from the time of database construction to March 2024. The quality of the literature was evaluated using the NOS scoring system. Meta-analysis was performed using R language software. Statistical heterogeneity was assessed using the I2 statistic, and sensitivity analysis was performed.
RESULTS: Six relevant literatures that met the criteria were finally included, and 652 patients were included, including 316 (48.5%) in the robot-assisted lateral lymph node dissection for rectal cancer group (RLLND) and 336 (51.5%) in the laparoscopic lateral lymph node dissection for rectal cancer group (LLLND). Analysis of the results showed that compared with the laparoscopic group, the robotic group had less mean intraoperative blood loss (MD = - 22, 95% CI - 40.03 to - 3.97, P < 0.05), longer operative time (MD = 51.57, 95%CI 7.69 to 95.45, P < 0.05), and a shorter mean hospital stay (MD = - 1.25, 95%CI - 2.46 to - 0.05, P < 0.05), a low rate of urinary complications (OR 0.39, 95%CI 0.23 to 0.64, P < 0.01), a low overall rate of postoperative complications (OR 0.6, 95%CI 0.42 to 0.87, P < 0.01), and a high number of lateral lymph node dissection (MD = 1.18, 95% CI 0.14 to 2.23, P < 0.05), and there was no statistically significant difference between the two groups in terms of postoperative anastomotic leakage, postoperative intestinal obstruction, and total number of lymph nodes obtained (P > 0.05).
CONCLUSIONS: Compared with laparoscopy, robotic lateral lymph node dissection for rectal cancer reduces intraoperative blood loss, shortens the average length of hospital stay, reduces urologic complications, decreases overall postoperative complications, and collects more lateral lymph nodes. However, the surgical time is prolonged.
METHODS: Databases were searched, including PubMed, EMBASE, Cochrane, and Web of Science. The search was conducted from the time of database construction to March 2024. The quality of the literature was evaluated using the NOS scoring system. Meta-analysis was performed using R language software. Statistical heterogeneity was assessed using the I2 statistic, and sensitivity analysis was performed.
RESULTS: Six relevant literatures that met the criteria were finally included, and 652 patients were included, including 316 (48.5%) in the robot-assisted lateral lymph node dissection for rectal cancer group (RLLND) and 336 (51.5%) in the laparoscopic lateral lymph node dissection for rectal cancer group (LLLND). Analysis of the results showed that compared with the laparoscopic group, the robotic group had less mean intraoperative blood loss (MD = - 22, 95% CI - 40.03 to - 3.97, P < 0.05), longer operative time (MD = 51.57, 95%CI 7.69 to 95.45, P < 0.05), and a shorter mean hospital stay (MD = - 1.25, 95%CI - 2.46 to - 0.05, P < 0.05), a low rate of urinary complications (OR 0.39, 95%CI 0.23 to 0.64, P < 0.01), a low overall rate of postoperative complications (OR 0.6, 95%CI 0.42 to 0.87, P < 0.01), and a high number of lateral lymph node dissection (MD = 1.18, 95% CI 0.14 to 2.23, P < 0.05), and there was no statistically significant difference between the two groups in terms of postoperative anastomotic leakage, postoperative intestinal obstruction, and total number of lymph nodes obtained (P > 0.05).
CONCLUSIONS: Compared with laparoscopy, robotic lateral lymph node dissection for rectal cancer reduces intraoperative blood loss, shortens the average length of hospital stay, reduces urologic complications, decreases overall postoperative complications, and collects more lateral lymph nodes. However, the surgical time is prolonged.
摘要：
背景：对机器人辅助和腹腔镜下直肠癌外侧淋巴结清扫术的围手术期和肿瘤学结果进行了荟萃分析。关于这个主题的文章和报告很少，缺乏高质量的研究成果和不可靠的研究结论。这项研究包括前瞻性和回顾性研究，以获得更可靠的发现。
方法：搜索数据库，包括PubMed,EMBASE,科克伦,和WebofScience。搜索是从数据库建设到2024年3月进行的。采用NOS评分系统评价文献质量。采用R语言软件进行Meta分析。使用I2统计量评估统计异质性，并进行敏感性分析。
结果：最终纳入了六篇符合标准的相关文献，并纳入了652名患者，包括机器人辅助的直肠癌外侧淋巴结清扫术（RLLND）中的316（48.5％）和腹腔镜直肠癌外侧淋巴结清扫术（LLLND）中的336（51.5％）。结果分析表明,与腹腔镜组相比,机器人组术中平均出血量较少(MD=-22,95%CI-40.03~-3.97,P<0.05),手术时间较长(MD=51.57,95CI=7.69~95.45,P<0.05),平均住院时间较短（MD=-1.25，95CI-2.46至-0.05，P<0.05），泌尿系并发症发生率低(OR0.39,95CI0.23~0.64,P<0.01),术后并发症的总体发生率较低（OR0.6，95CI0.42至0.87，P<0.01），外侧淋巴结清扫数较多(MD=1.18,95%CI0.14~2.23,P<0.05),两组在术后吻合口漏方面无统计学差异,术后肠梗阻,获得的淋巴结总数（P>0.05）。
结论：与腹腔镜相比，机器人外侧淋巴结清扫术可减少直肠癌术中失血，缩短了平均住院时间,减少泌尿系统并发症，减少整体术后并发症，收集更多的外侧淋巴结。然而,手术时间延长。
方法：搜索数据库，包括PubMed,EMBASE,科克伦,和WebofScience。搜索是从数据库建设到2024年3月进行的。采用NOS评分系统评价文献质量。采用R语言软件进行Meta分析。使用I2统计量评估统计异质性，并进行敏感性分析。
结果：最终纳入了六篇符合标准的相关文献，并纳入了652名患者，包括机器人辅助的直肠癌外侧淋巴结清扫术（RLLND）中的316（48.5％）和腹腔镜直肠癌外侧淋巴结清扫术（LLLND）中的336（51.5％）。结果分析表明,与腹腔镜组相比,机器人组术中平均出血量较少(MD=-22,95%CI-40.03~-3.97,P<0.05),手术时间较长(MD=51.57,95CI=7.69~95.45,P<0.05),平均住院时间较短（MD=-1.25，95CI-2.46至-0.05，P<0.05），泌尿系并发症发生率低(OR0.39,95CI0.23~0.64,P<0.01),术后并发症的总体发生率较低（OR0.6，95CI0.42至0.87，P<0.01），外侧淋巴结清扫数较多(MD=1.18,95%CI0.14~2.23,P<0.05),两组在术后吻合口漏方面无统计学差异,术后肠梗阻,获得的淋巴结总数（P>0.05）。
结论：与腹腔镜相比，机器人外侧淋巴结清扫术可减少直肠癌术中失血，缩短了平均住院时间,减少泌尿系统并发症，减少整体术后并发症，收集更多的外侧淋巴结。然而,手术时间延长。
