常规进行远端胃切除术(DG)和淋巴结清扫术治疗胃癌。在这个荟萃分析中,我们提供了腹腔镜DG(LDG)和机器人DG(RDG)的围手术期和肿瘤学结局的最新概述,以比较DG患者的安全性和总体结局.使用MEDLINE进行了广泛的搜索,EMBASE,PubMed,WebofScience,从数据库建立到2023年6月,Cochrane中央对照试验登记册用于比较RDG和LDG的随机临床试验。主要结果是手术结果,术后恢复,并发症,切除的充分性,和长期生存。我们确定了20项研究,评估5,447例患者(1,968例和3,479例接受RDG和LDG治疗的患者,分别)。我们观察到两组在近端切缘方面无显著差异,解剖的淋巴结数量,主要并发症,吻合部位渗漏,时间到了第一次排气,和住院时间。RDG组手术时间较长(P<0.00001),出血较少(P=0.0001),远端切除边缘较长(P=0.02),较早的口服时间(P=0.02),总体并发症较少(P=0.004),且费用高于LDG组(P<0.0001)。由于可接受的并发症和根治性切除的可能性,RDG是改善LDG的有前途的方法。更长的手术时间和更高的成本不应该阻止研究人员探索机器人手术的新应用。
Distal gastrectomy (DG) with lymph node dissection for gastric cancer is routinely performed. In this meta-analysis, we present an updated overview of the perioperative and oncological outcomes of laparoscopic DG (LDG) and robotic DG (RDG) to compare their safety and overall outcomes in patients undergoing DG. An extensive search was conducted using the MEDLINE, EMBASE, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials from the establishment of the database to June 2023 for randomized clinical trials comparing RDG and LDG. The primary outcome was operative results, postoperative recovery, complications, adequacy of resection, and long-term survival. We identified twenty studies, evaluating 5,447 patients (1,968 and 3,479 patients treated with RDG and LDG, respectively). We observed no significant differences between the two groups in terms of the proximal resection margin, number of dissected lymph nodes, major complications, anastomosis site leakage, time to first flatus, and length of hospital stay. The RDG group had a longer operative time (P < 0.00001), lesser bleeding (P = 0.0001), longer distal resection margin (P = 0.02), earlier time to oral intake (P = 0.02), fewer overall complications (P = 0.004), and higher costs (P < 0.0001) than the LDG group. RDG is a promising approach for improving LDG owing to acceptable complications and the possibility of radical resection. Longer operative times and higher costs should not prevent researchers from exploring new applications of robotic surgery.