Robotic <i>versus</i> laparoscopic intersphincteric resection for low rectal cancer: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Laiyuan ¹ , YANG Xiongfei ¹ , FENG Lili ¹ , GUO Yinyin ² , ZHANG Honglai ¹ , XU Shiyun ¹ , LÜ Yaochun ¹ , WU Dewang ¹ , CHEN Yifeng ¹ ,  ZHANG Weisheng ¹

1. Department of Colorectal Surgery, Gansu Provincial Hospital, Lanzhou 730000, P. R. China;
2. Department of Pharmacy, The Second Hospital of Lanzhou University, Lanzhou 730050, P. R. China;

Corresponding author：

ZHANG Weisheng, Email: zh9189@sina.com

Keywords：

laparoscopic surgery; Robotic surgery; intersphincteric resection; low rectal cancer

DOI：

10.7507/1007-9424.201905064

Video：

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Objective To evaluate the efficacy of robotic intersphincteric resection (ISR) for rectal cancer.Methods A literature search was performed using the China biomedical literature database, Chinese CNKI, Wanfang, PubMed, Embase, and the Cochrane library. The retrieval time was from the establishment of databases to April 1, 2019. Related interest indicators were brought into meta-analysis by Review Manager 5.2 software.Results A total of 510 patients were included in 5 studies, including 273 patients in the robot group and 237 patients in the laparoscopic group. As compared to the laparoscopic group, the robot group had significantly longer operative time [MD=43.27, 95%CI (16.48, 70.07), P=0.002], less blood loss [MD=–19.98.27, 95%CI (–33.14, –6.81), P=0.003], lower conversion rate [MD=0.20, 95%CI (0.04, –0.95), P=0.04], less lymph node harvest [MD=–1.71, 95%CI (–3.21, –0.21), P=0.03] and shorter hospital stay [MD=–1.61, 95%CI (–2.26, –0.97), P<0.000 01]. However, there were no statistically significant differences in the first flatus [MD=–0.01, 95%CI (–0.48, 0.46), P=0.96], time to diet [MD=–0.20, 95%CI (–0.67, 0.27), P=0.41], incidence of complications [OR=0.76, 95%CI (0.50, 1.14), P=0.18], distal resection margin [MD=0.00, 95%CI (–0.17, 0.17), P=0.98] and positive rate of circumferential resection margin [OR=0.61, 95%CI (0.27, 1.37), P=0.23].Conclusions Robotic and laparoscopic ISR for rectal cancer shows comparable perioperative outcomes. Compared with laparoscopic ISR, robotic ISR has the advantages of less blood loss, lower conversion rate, and longer operation times. These findings suggest that robotic ISR is a safe and effective technique for treating low rectal cancer.

Citation： LI Laiyuan, YANG Xiongfei, FENG Lili, GUO Yinyin, ZHANG Honglai, XU Shiyun, LÜ Yaochun, WU Dewang, CHEN Yifeng, ZHANG Weisheng. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(12): 1445-1451. doi: 10.7507/1007-9424.201905064 Copy

1.	Akagi Y, Kinugasa T, Shirouzu K. Intersphincteric resection for very low rectal cancer: a systematic review. Surg Today, 2013, 43(8): 838-847.
2.	Fegiz G, Indinnimeo M, Gozzo P, et al. Low rectal cancer-what is the choice? Dis Colon Rectum, 1994, 37(2 Suppl): S35-S41.
3.	王振军, 魏广辉. 经肛门切除内括约肌的低位直肠癌保肛术 40 例临床经验. 中华外科杂志, 2007, 45(17): 1173-1175.
4.	Park SY, Choi GS, Park JS, et al. Robotic-assisted transabdominal intersphincteric resection: a technique involving a completely abdominal approach and coloanal anastomosis. Surg Laparosc Endosc Percutan Tech, 2013, 23(1): e5-e10.
5.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
6.	Deeks JJ, Higgins JPT. Altman, Altman DG. Analysing data and undertaking meta-analyses. // Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. 2008: 243-296.
7.	Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Medical Research Methodology, 2005, 5: 13.
8.	Tierney JF, Stewart LA, Ghersi D, et al. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials, 2007, 8: 16.
9.	Park JS, Kim NK, Kim SH, et al. Multicentre study of robotic intersphincteric resection for low rectal cancer. Br J Surg, 2015, 102(12): 1567-1573.
10.	Yoo BE, Cho JS, Shin JW, et al. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: comparison of the operative, oncological, and functional outcomes. Ann Surg Oncol, 2015, 22(4): 1219-1225.
11.	Kuo LJ, Lin YK, Chang CC, et al. Clinical outcomes of robot-assisted intersphincteric resection for low rectal cancer: comparison with conventional laparoscopy and multifactorial analysis of the learning curve for robotic surgery. Int J Colorectal Dis, 2014, 29(5): 555-562.
12.	Baek SJ, Al-Asari S, Jeong DH, et al. Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer. Surg Endosc, 2013, 27(11): 4157-4163.
13.	Park SY, Choi GS, Park JS, et al. Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy. Surgical endoscopy, 2013, 27(1): 48-55.
14.	Sutton AJ, Duval SJ, Tweedie RL, et al. Empirical assessment of effect of publication bias on meta-analyses. BMJ, 2000, 320(7249): 1574-1577.
15.	薛艺珂. 结直肠微创手术的质量评估. 中国普外基础与临床杂, 2016, 23(8): 977.
16.	Lee SH, Lim S, Kim JH, et al. Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Ann Surg Treat Res, 2015, 89(4): 190-201.
17.	Jayne D, Pigazzi A, Marshall H, et al. Effect of Robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: The ROLARR randomized clinical trial. JAMA, 2017, 318(16): 1569-1580.
18.	管秀雯, 甘志明, 汪晓东, 等. 高龄直肠或肛管癌患者的两种极限保肛术式的术后近期结果的比较研究. 中国普外基础与临床杂志, 2013, 20(11): 1250-1256.
19.	郑芳, 阳川华, 汪晓东, 等. 全直肠系膜切除+经肛门内括约肌切除术治疗超低位直肠癌和直肠肛管癌的近期疗效. 中国普外基础与临床杂志, 2012, 19(7): 753-756.
20.	甘志明, 阳川华, 汪晓东, 等. 高龄对超低位直肠或肛管癌患者行经内外括约肌间切除术后近期疗效的影响. 中国普外基础与临床杂志, 2018, 25(7): 807-811.
21.	Bretagnol F, Lelong B, Laurent C, et al. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg Endosc, 2005, 19(7): 892-896.
22.	李世拥. 超低位直肠癌肛门内括约肌切除保肛术的技巧及评价. 中华胃肠外科杂志, 2011, 14(4): 302-303.
23.	王振军, 梁小波, 杨新庆, 等. 经肛门内外括约肌间切除直肠的直肠癌根治术疗效评价. 中华胃肠外科杂志, 2006, 9(2): 111-113.
24.	Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? Br J Surg, 1982, 69(10): 613-616.
25.	Heald RJ, Moran BJ, Ryall RD, et al. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg, 1998, 133(8): 894-899.

1. Akagi Y, Kinugasa T, Shirouzu K. Intersphincteric resection for very low rectal cancer: a systematic review. Surg Today, 2013, 43(8): 838-847.
2. Fegiz G, Indinnimeo M, Gozzo P, et al. Low rectal cancer-what is the choice? Dis Colon Rectum, 1994, 37(2 Suppl): S35-S41.
3. 王振军, 魏广辉. 经肛门切除内括约肌的低位直肠癌保肛术 40 例临床经验. 中华外科杂志, 2007, 45(17): 1173-1175.
4. Park SY, Choi GS, Park JS, et al. Robotic-assisted transabdominal intersphincteric resection: a technique involving a completely abdominal approach and coloanal anastomosis. Surg Laparosc Endosc Percutan Tech, 2013, 23(1): e5-e10.
5. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
6. Deeks JJ, Higgins JPT. Altman, Altman DG. Analysing data and undertaking meta-analyses. // Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. 2008: 243-296.
7. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Medical Research Methodology, 2005, 5: 13.
8. Tierney JF, Stewart LA, Ghersi D, et al. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials, 2007, 8: 16.
9. Park JS, Kim NK, Kim SH, et al. Multicentre study of robotic intersphincteric resection for low rectal cancer. Br J Surg, 2015, 102(12): 1567-1573.
10. Yoo BE, Cho JS, Shin JW, et al. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: comparison of the operative, oncological, and functional outcomes. Ann Surg Oncol, 2015, 22(4): 1219-1225.
11. Kuo LJ, Lin YK, Chang CC, et al. Clinical outcomes of robot-assisted intersphincteric resection for low rectal cancer: comparison with conventional laparoscopy and multifactorial analysis of the learning curve for robotic surgery. Int J Colorectal Dis, 2014, 29(5): 555-562.
12. Baek SJ, Al-Asari S, Jeong DH, et al. Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer. Surg Endosc, 2013, 27(11): 4157-4163.
13. Park SY, Choi GS, Park JS, et al. Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy. Surgical endoscopy, 2013, 27(1): 48-55.
14. Sutton AJ, Duval SJ, Tweedie RL, et al. Empirical assessment of effect of publication bias on meta-analyses. BMJ, 2000, 320(7249): 1574-1577.
15. 薛艺珂. 结直肠微创手术的质量评估. 中国普外基础与临床杂, 2016, 23(8): 977.
16. Lee SH, Lim S, Kim JH, et al. Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Ann Surg Treat Res, 2015, 89(4): 190-201.
17. Jayne D, Pigazzi A, Marshall H, et al. Effect of Robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: The ROLARR randomized clinical trial. JAMA, 2017, 318(16): 1569-1580.
18. 管秀雯, 甘志明, 汪晓东, 等. 高龄直肠或肛管癌患者的两种极限保肛术式的术后近期结果的比较研究. 中国普外基础与临床杂志, 2013, 20(11): 1250-1256.
19. 郑芳, 阳川华, 汪晓东, 等. 全直肠系膜切除+经肛门内括约肌切除术治疗超低位直肠癌和直肠肛管癌的近期疗效. 中国普外基础与临床杂志, 2012, 19(7): 753-756.
20. 甘志明, 阳川华, 汪晓东, 等. 高龄对超低位直肠或肛管癌患者行经内外括约肌间切除术后近期疗效的影响. 中国普外基础与临床杂志, 2018, 25(7): 807-811.
21. Bretagnol F, Lelong B, Laurent C, et al. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg Endosc, 2005, 19(7): 892-896.
22. 李世拥. 超低位直肠癌肛门内括约肌切除保肛术的技巧及评价. 中华胃肠外科杂志, 2011, 14(4): 302-303.
23. 王振军, 梁小波, 杨新庆, 等. 经肛门内外括约肌间切除直肠的直肠癌根治术疗效评价. 中华胃肠外科杂志, 2006, 9(2): 111-113.
24. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? Br J Surg, 1982, 69(10): 613-616.
25. Heald RJ, Moran BJ, Ryall RD, et al. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg, 1998, 133(8): 894-899.

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Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a meta-analysis

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