机器人与腹腔镜胃癌D2根治术近期疗效对比Meta分析

Short-term efficacy of robotic gastrectomy vs.laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer:A Meta-analysis

目的系统评价达芬奇机器人手术系统与腹腔镜手术在治疗胃癌时行D2淋巴结清扫的近期疗效。方法手动检索多个国内外数据库,收集2005年1月至2015年11月公开发表的有关于机器人胃癌手术(robotic gastrectomy,RG)和腹腔镜胃癌根治术(laparoscopic gastrectomy,LG)临床疗效的相关对比的文献,按照纳入和排除标准进行筛选文献,提取相关数据后进行Meta分析。计量资料使用加权均数差(weighted mean difference,WMD)及用95%可信区间(95%CI)为合并统计量,二分类资料采用比值比(odds ratio,OR)及95%CI表示。采用I^2用来评估异质性的大小。结果共有6篇文献纳入此次研究,累计样本量1 177例,其中RG组419例,LG组758例。Meta分析结果显示:两组在选择病人时体质量指数上无明显差异(WMD=0.0;95%CI:-0.49,0.48);与LG组比较,RG组手术时间相对较长(WMD=58.89;95%CI:24.31,93.47),但术中出血量更少(WMD=-44.41;95%CI:-60.60,-28.22)、术后首次进食更早(WMD=-0.27;95%CI:-0.48,-0.06)和术后住院时间更短(WMD=-1.02;95%CI:-1.83,-0.24),同时在术中淋巴清扫数目(WMD=0.52;95%CI:-1.86,2.90)与术后并发症发生率(OR=0.59;95%CI:0.33,1.04)等方面差异无统计学意义。结论运用机器人系统在治疗胃癌时行D2根治术具有一定的安全性及可行性,但仍需多中心、大样本随机对照研究来验证。

Objective To evaluate the short-term efficacy of da Vinci robotic vs. laparoscopic gastrectomy with I32 lymphadeneetomy for gastric cancer. Methods Relevant studies comparing robot- ic gastrectomy （RG） with laparoscopic gastrectomy （LG） published between January 2005 and Decem- ber 2015 in the major domestic and foreign databases were retrieved. After screening for inclusion and exclusion criteria, data extraction and quality assessment, Meta-analysis was performed by Stata 12. 0 software. The measurement data and count data were analyzed using weighted mean difference （WMD） and odds ratio （OR） with Corresponding 95 % confidence intervals （95 % CIs）, respectively. I^2 was used to assess the heterogeneity. Results A total of six studies with 1177 patients （419 cases in the RG group and 758 cases in LG group） were included in this Meta-analysis. There was no signifi- cant difference in the body mass index between the two groups （WMD： 0. 0; 95% CI： -0.49, 0. 48）. Compared with LG, RG had longer operative time （WMD.. 58. 89; 95% CI： 24. 31, 93. 47）, but experienced less blood loss （WMD ： - 44. 41 ; 95% CI： - 60. 60, - 28. 22）, shorter time of oral intake （WMD.. - 0. 27,95% CI： - O. 48, - 0. 06） and postoperative hospital stay （WMD. - 1.02; 95% CI： - 1.83, -0. 24）. The retrieved lymph nodes （WMD： 0. 52; 95% CI： - 1.86, 2. 90） and postoperative hospital stay （OR： 0. 59; 95% CI： 0. 33, 1.04） showed no significant difference between the two groups. Conclusiom Da Vinci robotic gastreetomy with D2 lymphadeneetomy for gastric cancer is safe and feasible, and multi-center randomized controlled study is still needed to validate these results.