【评论】机器人和传统腹腔镜手术对直肠癌患者环周切缘阳性风险的对比研究:一项系统综述和Meta分析

[Comment]Robotic surgery is associated with a decreased risk of circumferential resection margin positivity compared with conventional laparoscopic surgery in patients with rectal cancer undergoing mesorectal excision:a systematic review and meta-analysis

目的研究机器人手术相比传统腹腔镜手术是否能够降低直肠癌行直肠系膜切除术后出现环周切缘阳性的风险。背景众所周知,接受直肠系膜切除术的直肠癌患者中,环周切缘阳性会影响术后预后,但目前机器人手术在降低环周切缘阳性风险方面是否优于传统腹腔镜手术的研究较少。方法我们对截至2022年12月的相关文献进行了全面检索,以识别接受机器人手术和传统腹腔镜手术的直肠癌患者中环周切缘阳性风险的对比研究。使用随机效应模型进行荟萃分析,计算风险比和95%置信区间,并使用I^(2)统计量分析异质性。结果本荟萃分析共纳入18项研究,包括4项随机对照研究和14项倾向评分匹配研究,涉及9203例接受直肠系膜切除术的直肠癌患者。结果显示,与传统腹腔镜手术相比,机器人手术降低了总体环周切缘阳性风险(风险比为0.82,95%置信区间为0.73~0.92,P=0.001,I^(2)=0%)。对4项随机对照研究的荟萃分析结果也表明,机器人手术降低了环周切缘阳性风险(风险比为0.62,95%置信区间为0.43~0.91,P=0.01,I^(2)=0%)。结论本荟萃分析显示,在接受直肠系膜切除术的直肠癌患者中,与传统腹腔镜手术相比,机器人手术与降低环周切缘阳性风险相关。

Objective To investigate whether robotic surgery(RS)decreases the risk of circumferential resection margin(CRM)positivity compared with conventional laparoscopic surgery(LS)in patients with rectal cancer(RC)undergoing mesorectal excision(ME).Background Although it is well known that CRM positivity affects postoperative outcomes in patients with RC undergoing ME,few studies have investigated whether RS is superior to conventional LS for the risk of CRM positivity.Methods We performed a comprehensive electronic search of the literature up to December 2022 to identify studies that compared the risk of CRM positivity between patients with RC undergoing robotic and conventional laparoscopic surgery.A meta-analysis was performed using random-effects models to calculate risk ratios(RR)and 95%confidence intervals(CI),and heterogeneity was analyzed using I 2 statistics.Results Eighteen studies,consisting of 4 randomized controlled trials(RCTs)and 14 propensity score matching(PSM)studies,involved a total of 9,203 patients with RC who underwent ME were included in this meta-analysis.The results demonstrated that RS decreased the overall risk of CRM positivity(RR,0.82;95%CI,0.73-0.92;P=0.001;I^(2)=0%)compared with conventional LS.Results of a metaanalysis of the 4 selected RCTs also showed that RS decreased the risk of CRM positivity(RR,0.62;95%CI,0.43-0.91;P=0.01;I^(2)=0%)compared with conventional LS.Conclusions This meta-analysis revealed that RS is associated with a decreased risk of CRM positivity compared with conventional LS in patients with RC undergoing ME.