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

Abstract

PurposeReports 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.MethodsWe 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).ResultsThe 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).ConclusionWe 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.

Robotic versus thoracoscopic thymectomy: The current evidence

“…Despite the concerns regarding the small number of conversions, there was no heterogeneity observed between the two studies. A meta‐analysis of comparisons of robotic versus laparoscopic approaches in colorectal cancer reported similar results …”

Robotic surgery for colorectal cancer

“…To date, no differences have been observed in lymph nodes resected using the different approaches, although the robotic approach is favored. 19,20,21,22,23,27,28,31 As in the case of surgical wound infection, it will be interesting to keep an eye on the future impact of robotic surgery in the standardization of minimally invasive complete mesocolic excision or lateral lymph node resection in areas of the world like Europe or the United States where these techniques are not fully implemented. This might lead to an increase in the rate of harvested lymph nodes when the robotic approach is used.…”

“…Two recently published studies 19,26 found that robotic surgery was associated with a significant reduction in the mortality rate, although this was not corroborated in other systematic reviews/ meta-analyses. 20,23,27,28…”

Minimally invasive right colectomy - from conventional laparoscopic resection to robotic-assisted surgery: a narrative review

“…Several studies have demonstrated the safety and efficacy of RRC for both short-and long-term outcomes [31,60,70,71] . Only one randomized controlled trial found no differences in lengths of hospital stay and the surgical complications rate between RRC and LRC groups [72] .…”

“…Solaini et al [60] reported that conversion to open surgery was more common during LRC, with no significant differences in mortality and postoperative complication rate. Lim et al [70] concluded that the time for diet, first flatus, and first defecation, and the length of hospital stay were significantly decreased for RRC. Similarly, Rondelli et al [74] showed that the time for the first flatus was significantly shorter in RRC.…”