Ann Surg Treat Res.  2016 Jun;90(6):328-339. 10.4174/astr.2016.90.6.328.

Comparison of perioperative and short-term outcomes between robotic and conventional laparoscopic surgery for colonic cancer: a systematic review and meta-analysis

• Lim S
• Kim JH
• Baek SJ
• Kim SH
• Lee SH

• KMID: 2164794
• DOI: http://doi.org/10.4174/astr.2016.90.6.328

Abstract

PURPOSE
Reports from several case series have described the feasibility and safety of robotic surgery (RS) for colonic cancer. Experience is still limited in robotic colonic surgery, and a few meta-analysis has been conducted to integrate the results for colon cancer specifically. We conducted a systematic review of the available evidence comparing the surgical safety and efficacy of RS with that of conventional laparoscopic surgery (CLS) for colonic cancer.
METHODS
We searched English databases (MEDLINE, Embase, and Cochrane Library), and Korean databases (KoreaMed, KMbase, KISS, RISS, and KisTi). Dichotomous variables were pooled using the risk ratio, and continuous variables were pooled using the mean difference (MD).
RESULTS
The present study found that the RS group had a shorter time to resumption of a regular diet (MD, -0.62 days; 95% CI, -0.97 to -0.28), first passage of flatus (MD, -0.44 days; 95% CI, -0.66 to -0.23) and defecation (MD, -0.62 days; 95% CI, -0.77 to -0.47). Also, RS was associated with a shorter hospital stay (MD, -0.69 days; 95% CI, -1.12 to -0.26), a lower estimated blood loss (MD, -19.49 mL; 95% CI, -27.10 to -11.89) and a longer proximal margin (MD, 2.29 cm; 95% CI, 1.11-3.47). However, RS was associated with a longer surgery time (MD, 51.00 minutes; 95% CI, 39.38-62.62).
CONCLUSION
We found that the potential benefits of perioperative and short-term outcomes for RS than for CLS. For a more accurate understanding of RS for colonic cancer patients, robust comparative studies and randomized clinical trials are required.

Keyword

Robotic surgical procedures; Colonic neoplasms

MeSH Terms

Colon*
Colonic Neoplasms*
Defecation
Diet
Flatulence
Humans
Laparoscopy*
Length of Stay
Odds Ratio
Robotic Surgical Procedures

Figure

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  Fig. 1 Flow diagram of the study selection process. RS, robotic surgery; CLS, conventional laparoscopic surgery.

• 

  Fig. 2 Quality assessment of included studies. Quality assessment was performed using cochrane risk of bias (RoB) for randomized controlled trials and nonrandomized studies (RoBANS 2.0) for nonrandomized comparative studies. Green, low risk of bias; yellow, unclear; red, high risk of bias.

• 

  Fig. 3 Forest plot and meta-analysis of time to regular diet (A); time to first flatus (B); time to first defecation (C); number of proximal margin (D); operative time (E); length of stay (F); and estimated blood loss (G). SD, standard deviation; CI, confidence interval; RCT, randomized controlled trial.

• 

  Fig. 4 Funnel plot of the studies used in the meta-analysis. SE (MD), standard error (mean difference); RCT, randomized controlled trial.

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