机器人辅助与传统腹腔镜胰体尾切除术治疗胰腺恶性肿瘤疗效比较的Meta分析

Meta-analysis of efficacy of robotic-assisted versus conventional laparoscopic distal pancreatectomy for malignant pancreatic diseases

背景与目的:目前手术切除依旧是胰腺恶性肿瘤的首选治疗方法,但采用机器人胰体尾切除术(RDP)还是腹腔镜胰体尾切除术(LDP)争议很大。本研究通过Meta分析方法评价RDP与LDP在治疗胰腺恶性肿瘤患者的有效性与安全性,以获得循证学证据为临床决策提供依据。方法:计算机检索多个国内外数据库,收集比较关于RDP与LDP治疗胰腺恶性肿瘤临床疗效的文献,检索时限均为建库至2021年3月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果:最终纳入15篇文献,共2 940例患者,其中997例行RDP,1 943例行LDP。Meta分析结果显示:与LDP比较,RDP的保脾率提高(OR=2.31,95%CI=1.37~3.90,P=0.002),术中中转开腹率(OR=0.36,95%CI=0.24~0.52,P<0.000 01)、90 d再手术率(OR=0.46,95%CI=0.24~0.89,P=0.02)和30 d病死率(OR=0.18,95%CI=0.06~0.53,P=0.002)均降低,手术时间延长(MD=-40.09,95%CI=-77.64~-2.54,P=0.04),淋巴结清扫数量增多(MD=2.06,95%CI=0.65~3.47,P=0.004);而在术中出血量、总并发症率、伤口感染、胰瘘、住院时间、90 d再入院率等差异均无统计学意义(均P>0.05)。结论:当前的证据表明,与LDP比较,RDP能提高保脾率和淋巴结清扫数目,降低中转开腹率、90 d再手术率及30 d病死率。这表明RDP与LDP在胰腺恶性肿瘤治疗上有着相似的安全性和有效性。受纳入研究数量和质量限制,上述结论还需多中心、大样本随机对照试验予以验证。

Background and Aims: Surgical resection is still the preferred treatment for malignant pancreatic diseases at present. However, the use of robotic-assisted distal pancreatectomy(RDP) or laparoscopic distal pancreatectomy(LDP) is still controversial. This study was conducted to evaluate the efficacy and safety of using RDP and LDP in the treatment of patients with malignant pancreatic diseases by Metaanalysis, so as to obtain evidence-based information to provide basis for clinical decision-making.Methods: The studies comparing the clinical efficacy of RDP versus LDP for malignant pancreatic diseases were collected by a computer-based search in several national and international databases from their inception to March 2021. After literature screening, data extraction and bias risk evaluation by two reviewers independently, Meta-analysis was performed using RevMan 5.4 software.Results: Fifteen studies were finally included, involving 2 940 patients, of whom, 997 cases underwent RDP and 1 943 cases underwent LDP. The results of Meta-analysis showed that in RDP group compared with LDP group, the spleen preservation rate(OR=2.31, 95% CI=1.37-3.90, P=0.002) was increased, the intraoperative conversion rate(OR=0.36, 95% CI=0.24-0.52, P<0.000 01), 90-d reoperation rate(OR=0.46, 95% CI=0.24-0.89, P=0.02), and 30-d mortality(OR=0.18, 95% CI=0.06-0.53, P=0.002)were reduced, the operative time was prolonged(MD=-40.09, 95% CI=-77.64-2.54, P=0.04), and the number of lymph nodes harvested(MD=2.06, 95% CI=0.65-3.47, P=0.004) was increased. However, no significant differences were found in intraoperative blood loss, total complication rate, surgical site infection, pancreatic fistula, length of hospital stay, and 90-d readmission rate(all P>0.05).Conclusion: The current evidence indicates that RDP may increase the spleen preservation rate and the number of lymph nodes harvested, and reduce open conversion rate, 90-d reoperation rate, and 30-d mortality compared with LDP. These results indicate that RDP and LDP have similar safety and efficacy in the treatment of malignant pancreatic diseases. Limited by the quality and quantity of the included studies, the above conclusions need to be verified by more multicenter randomized controlled trials with large sample size.