TY - JOUR
T1 - Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates
T2 - a meta-analysis of randomized controlled trials and propensity-score-matched studies
AU - Phan, K.
AU - Kahlaee, H. R.
AU - Kim, S. H.
AU - Toh, J. W.T.
N1 - Funding Information:
Acknowledgements Dr James W. T. Toh received the Morgan Fellowship from the Royal Australasian College of Surgeons to conduct his international robotic fellowship in Korea.
Publisher Copyright:
© 2019, Springer Nature Switzerland AG.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Background: The usage of robotic surgery in rectal cancer is increasing, but there is an ongoing debate as to whether it provides any benefit. The aim of the present study was to determine if robotic surgery results in less conversion to an open operation than laparoscopic rectal cancer surgery. Methods: A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club and Database of Abstracts of Review of Effectiveness. Included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies comparing a robotic vs. laparoscopic approach to rectal cancer surgery. The primary endpoint was conversion to open. All statistical analyses and data synthesis were conducted using STATA/IC version 14·2, Windows 64 bit (StataCorp LP, College Station, TX, USA) Results: Six hundred and twenty-one studies were identified through electronic database search. After application of selection criteria as per PRISMA and MOOSE criteria, six RCTs and five PSM articles were analyzed. From the six RCTs, 512 robotic and 519 laparoscopic cases were evaluated. There was a significantly lower rate of conversion for the robotic surgery arm (4.1% vs. 8.1%, OR 0.28; 95% CI 0.00–0.57). Of the five PSM studies, 2097 robotic and 3053 laparoscopic cases were evaluated. There was a significantly lower conversion to open rate found in the robotic surgery cohort (7.4% vs. 15.6%; OR 0.39; 95% CI 0.30–0.47). Pooled RCT and PSM data demonstrated significantly lower conversion rates for robotic surgery (6.7% vs. 14.5%; OR 0.38; 95% CI 0.30–0.46). Conclusions: Robotic surgery for rectal cancer is associated with reduced conversion to open surgery compared to a laparoscopic approach.
AB - Background: The usage of robotic surgery in rectal cancer is increasing, but there is an ongoing debate as to whether it provides any benefit. The aim of the present study was to determine if robotic surgery results in less conversion to an open operation than laparoscopic rectal cancer surgery. Methods: A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club and Database of Abstracts of Review of Effectiveness. Included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies comparing a robotic vs. laparoscopic approach to rectal cancer surgery. The primary endpoint was conversion to open. All statistical analyses and data synthesis were conducted using STATA/IC version 14·2, Windows 64 bit (StataCorp LP, College Station, TX, USA) Results: Six hundred and twenty-one studies were identified through electronic database search. After application of selection criteria as per PRISMA and MOOSE criteria, six RCTs and five PSM articles were analyzed. From the six RCTs, 512 robotic and 519 laparoscopic cases were evaluated. There was a significantly lower rate of conversion for the robotic surgery arm (4.1% vs. 8.1%, OR 0.28; 95% CI 0.00–0.57). Of the five PSM studies, 2097 robotic and 3053 laparoscopic cases were evaluated. There was a significantly lower conversion to open rate found in the robotic surgery cohort (7.4% vs. 15.6%; OR 0.39; 95% CI 0.30–0.47). Pooled RCT and PSM data demonstrated significantly lower conversion rates for robotic surgery (6.7% vs. 14.5%; OR 0.38; 95% CI 0.30–0.46). Conclusions: Robotic surgery for rectal cancer is associated with reduced conversion to open surgery compared to a laparoscopic approach.
KW - Conversion to open surgery
KW - Laparoscopic surgery
KW - Meta-analysis
KW - RECTUM/surg
KW - Rectal cancer
KW - Robotic surgical procedures
UR - http://www.scopus.com/inward/record.url?scp=85059677579&partnerID=8YFLogxK
U2 - 10.1007/s10151-018-1920-0
DO - 10.1007/s10151-018-1920-0
M3 - Review article
C2 - 30623315
AN - SCOPUS:85059677579
SN - 1123-6337
VL - 23
SP - 221
EP - 230
JO - Techniques in Coloproctology
JF - Techniques in Coloproctology
IS - 3
ER -
