背景:评估了机器人低位前切除术(rTME)和经肛门全直肠系膜切除术(TaTME)在低位直肠癌患者中的比较结果。
方法:使用以下数据库进行了系统的在线搜索:PubMed,Scopus,Cochrane数据库,虚拟健康图书馆,临床试验.gov和科学直接。包括rTME与TaTME治疗低位直肠癌的比较研究。主要结果是术后并发症,包括吻合口漏,手术部位感染,和Clavien-Dindo并发症发生率。总手术时间,转换为开放手术,术中失血,强化治疗单位(ITU)和总住院时间(LOS),肿瘤结局和功能结局是其他评估的结局参数.
结果:共纳入12项研究,共3025例患者,分为rTME组(n=1881)和TaTME组(n=1144)。两组总手术时间差异无统计学意义(P=0.39)。转换为开放手术(P=0.29)和术中失血(P=0.62)。Clavien-Dindo≥3并发症发生率(P=0.47),吻合口漏(P=0.89),再手术率(P=0.62)和再入院率(P=0.92),R0切除(P=0.52),ITULOS(P=0.63)和总医院LOS(P=0.30)在两组之间也显示出相似的结果。然而,rTME组的总淋巴结切除率(P=0.04)和完全性全直肠系膜切除术(TME)率较高(P=0.05).尽管数据集有限,与TaTME组相比,rTME组的Wexner和低位前切除综合征(LARS)评分显示更好的功能结果(分别为P=0.0009和P=0.00001).
结论:与TaTME相比,rTME似乎提供了更好的功能结果,更高的淋巴结产率和更完整的TME切除,术后并发症情况相似。
BACKGROUND: Comparative outcomes of robotic low anterior resection (rTME) and trans-anal total mesorectal excision (TaTME) in patients with low rectal cancer were evaluated.
METHODS: A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies of rTME versus TaTME for low rectal cancer were included. Primary outcomes were postoperative complications, including anastomotic leak, surgical site infection, and Clavien-Dindo complication rate. Total operative time, conversion to open surgery, intra-operative blood loss, intensive therapy unit (ITU) and total hospital length of stay (LOS), oncological outcomes and functional outcomes were the other evaluated outcome parameters.
RESULTS: A total of 12 studies with a total number of 3025 patients divided between rTME (n = 1881) and TaTME (n = 1144) groups were included. There was no significant difference between the two groups for total operative time (P = 0.39), conversion to open surgery (P = 0.29) and intra-operative blood loss (P = 0.62). Clavien-Dindo ≥ 3 complication rate (P = 0.47), anastomotic leak (P = 0.89), rates of re-operation (P = 0.62) and re-admission (P = 0.92), R0 resections (P = 0.52), ITU LOS (P = 0.63) and total hospital LOS (P = 0.30) also showed similar results between the two groups. However, the rTME group had higher rates of total harvested lymph nodes (P = 0.04) and complete total mesorectal excision (TME) resections (P = 0.05). Albeit with a limited dataset, the Wexner and low anterior resection syndrome (LARS) scores showed better functional results in the rTME group compared with the TaTME group (P = 0.0009 and P = 0.00001, respectively).
CONCLUSIONS: Compared with TaTME, rTME seems to provide better functional outcomes, higher lymph node yield and more complete TME resections with a similar post-operative complications profile.