达芬奇机器人辅助与胸腹腔镜辅助微创食管癌切除术临床效果的系统评价与Meta分析

Efficacy of Da Vinci robot-assisted minimally invasive esophagectomy versus video-assisted minimally invasive esophagectomy:A systematic review and meta-analysis

目的系统评价达芬奇机器人辅助微创食管癌切除术(robot-assisted minimally invasive esophagectomy,RAMIE)和腔镜辅助微创食管癌切除术(video-assisted minimally invasive esophagectomy,VAMIE)的临床效果差异。方法计算机检索PubMed,EMbase、Medline、the Cochrane Library、CNKI数据库关于RAMIE和VAMIE临床效果对比的文献,检索时限为建库至2019年12月31日。由2名检索员独立筛选文献、提取资料。采用纽卡斯尔-渥太华量表评估文献质量,采用RevMan 5.3进行Meta分析。结果共14篇文献1160例患者纳入最终研究,其中12篇文献为高质量文献。RAMIE并不明显延长总手术时间(P=0.20);其中在McKeown手术中的胸部手术时间方面,RAMIE与VAMIE差异无统计学意义[MD=3.35,95%CI(–3.93,10.62),P=0.37];RAMIE与VAMIE术中出血量差异无统计学意义[MD=–9.48,95%CI(–27.91,8.95),P=0.31];RAMIE清扫淋巴结总数多于VAMIE[MD=2.24,95%CI(1.09,3.39),P=0.0001];RAMIE可清扫更多的左侧喉返神经旁淋巴结[MD=0.89,95%CI(0.13,1.65),P=0.02],降低术后声音嘶哑的发生率[RR=0.70,95%CI(0.53,0.92),P=0.009]。结论RAMIE与VAMIE在手术时间及术中出血量等方面差异无统计学意义。但RAMIE可清扫更多的淋巴结,尤其是左侧喉返神经旁淋巴结,减少清扫左侧喉返神经旁淋巴结时左侧喉返神经损伤的发生,从而降低术后声音嘶哑的发生率。

Objective To compare the surgical efficacy of Da Vinci robot-assisted minimally invasive esophagectomy(RAMIE)and video-assisted minimally invasive esophagectomy(VAMIE)on esophageal cancer.Methods Online databases including PubMed,the Cochrane Library,Medline,EMbase and CNKI from inception to 31,December 2019 were searched by two researchers independently to collect the literature comparing the clinical efficacy of RAMIE and VAMIE on esophageal cancer.Newcastle-Ottawa Scale was used to assess quality of the literature.The meta-analysis was performed by RevMan 5.3.Results A total of 14 studies with 1160 patients were enrolled in the final study,and 12 studies were of high quality.RAMIE did not significantly prolong total operative time(P=0.20).No statistical difference was observed in the thoracic surgical time through the McKeown surgical approach(MD=3.35,95%CI–3.93 to 10.62,P=0.37)or in surgical blood loss between RAMIE and VAMIE(MD=–9.48,95%CI–27.91 to 8.95,P=0.31).While the RAMIE could dissect more lymph nodes in total and more lymph nodes along the left recurrent laryngeal recurrent nerve(MD=2.24,95%CI 1.09 to 3.39,P=0.0001;MD=0.89,95%CI 0.13 to 1.65,P=0.02)and had a lower incidence of vocal cord paralysis(RR=0.70,95%CI 0.53 to 0.92,P=0.009).Conclusion There is no statistical difference observed between RAMIE and VAMIE in surgical time and blood loss.RAMIE can harvest more lymph nodes than VAMIE,especially left laryngeal nerve lymph nodes.RAMIE shows a better performance in reducing the left laryngeal nerve injury and a lower rate of vocal cord paralysis compared with VAMIE.