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01-11-2012 | Colorectal Cancer

Robot-Assisted Versus Conventional Laparoscopic Surgery for Colorectal Disease, Focusing on Rectal Cancer: A Meta-analysis

Authors: Yongzhi Yang, MS, Feng Wang, PhD, Peng Zhang, PhD, Chenzhang Shi, PhD, Yang Zou, MS, Huanlong Qin, MD, Yanlei Ma, PhD

Published in: Annals of Surgical Oncology | Issue 12/2012

Abstract

Background

Robotic colorectal surgery may solve some of the problems inherent to conventional laparoscopic surgery (CLS). We sought to evaluate the advantages of robot-assisted laparoscopic surgery (RALS) using the da Vinci Surgical System over CLS in patients with benign and malignant colorectal diseases.

Methods

PubMed and Embase databases were searched for relevant studies published before July 2011. Studies clearly documenting a comparison of RALS with CLS for benign and malignant colorectal diseases were selected. Operative and postoperative measures, resection margins, complications, and related outcomes were evaluated. Weighted mean differences, relative risks, and hazard ratios were calculated using a random-effects model.

Results

The meta-analysis included 16 studies comparing RALS and CLS in patients with colorectal diseases and 7 studies in rectal cancer. RALS was associated with lower estimated blood loss in colorectal diseases (P = 0.04) and rectal cancer (P < 0.001) and lower rates of intraoperative conversion in colorectal diseases (P = 0.03) and rectal cancer (P < 0.001) than CLS. In patients with colorectal diseases, however, operating time (P < 0.001) and total hospitalization cost (P = 0.06) were higher for RALS than for CLS.

Conclusions

RALS was associated with reduced estimated blood loss and a lower intraoperative conversion rate than CLS, with no differences in complication rates and surrogate markers of successful surgery. Robotic colorectal surgery is a promising tool, especially for patients with rectal cancer.

Buunen M, Veldkamp R, Hop WC, et al., Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10:44–52.PubMedCrossRef

Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol. 2006;13:413–24.PubMedCrossRef

Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.PubMedCrossRef

Sammour T, Kahokehr A, Srinivasa S, et al. Laparoscopic colorectal surgery is associated with a higher intraoperative complication rate than open surgery. Ann Surg. 2011;253:35–43.PubMedCrossRef

Corcione F, Esposito C, Cuccurullo D, et al. Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc. 2005;19:117–9.PubMedCrossRef

Modi P, Rodriguez E, Chitwood WR Jr. Robot-assisted cardiac surgery. Interact Cardiovasc Thorac Surg. 2009;9:500–5.PubMedCrossRef

Kruijdenberg CB, van den Einden LC, Hendriks JC, et al. Robot-assisted versus total laparoscopic radical hysterectomy in early cervical cancer: a review. Gynecol Oncol. 2011;120:334–9.PubMedCrossRef

Patel VR, Chammas MF Jr, Shah S. Robotic assisted laparoscopic radical prostatectomy: a review of the current state of affairs. Int J Clin Pract. 2007;61:309–14.PubMedCrossRef

Wadstrom J, Martin AL, Estok R, et al. Comparison of hand-assisted laparoscopy versus open and laparoscopic techniques in urology procedures: a systematic review and meta-analysis. J Endourol. 2011;25:1095–104.PubMedCrossRef

10.

Baek JH, McKenzie S, Garcia-Aguilar J, et al. Oncologic outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Ann Surg. 2010;251:882–6.PubMedCrossRef

11.

Baik SH, Ko YT, Kang CM, et al. Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc. 2008;22:1601–8.PubMedCrossRef

12.

Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.PubMedCrossRef

13.

Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.PubMedCrossRef

14.

DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.PubMedCrossRef

15.

Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13.PubMedCrossRef

16.

Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions, version 5.1.0. Updated March 2011. The Cochrane Collaboration, 2011. http://www.cochrane-handbook.org.

17.

Shepard DS, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996. J Ment Health Policy Econ. 1999;2:91–2.PubMedCrossRef

18.

Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.PubMedCrossRef

19.

Merola S, Weber P, Wasielewski A, et al. Comparison of laparoscopic colectomy with and without the aid of a robotic camera holder. Surg Laparosc Endosc Percutan Technol. 2002;12:46–51.CrossRef

20.

Anvari M, Birch DW, Bamehriz F, et al. Robotic-assisted laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Technol. 2004;14:311–5.CrossRef

21.

Baik SH, Kwon HY, Kim JS, et al. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol. 2009;16:1480–7.PubMedCrossRef

22.

Park JS, Choi GS, Lim KH, et al. Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes. Ann Surg Oncol. 2010;17:3195–202.PubMedCrossRef

23.

Park JS, Choi GS, Lim KH, et al. S052: a comparison of robot-assisted, laparoscopic, and open surgery in the treatment of rectal cancer. Surg Endosc. 2011;25:240–8.PubMedCrossRef

24.

Pigazzi A, Ellenhorn JD, Ballantyne GH, et al. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc. 2006;20:1521–5.PubMedCrossRef

25.

Baek JH, Pastor C, Pigazzi A. Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Surg Endosc. 2011;25:521–5.PubMedCrossRef

26.

Wong MT, Meurette G, Rigaud J, et al. Robotic versus laparoscopic rectopexy for complex rectocele: a prospective comparison of short-term outcomes. Dis Colon Rectum. 2011;54:342–6.PubMedCrossRef

27.

Patel CB, Ragupathi M, Ramos-Valadez DI, et al. A three-arm (laparoscopic, hand-assisted, and robotic) matched-case analysis of intraoperative and postoperative outcomes in minimally invasive colorectal surgery. Dis Colon Rectum. 2011;54:144–50.PubMedCrossRef

28.

Kwak JM, Kim SH, Kim J, et al. Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum. 2011;54:151–6.PubMedCrossRef

29.

Jimenez Rodriguez RM, Diaz Pavon JM, de La Portilla de Juan F, et al. Prospective randomised study: robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection. Cir Esp. 2011;89:432–8.PubMedCrossRef

30.

Popescu I, Vasilescu C, Tomulescu V, et al. The minimally invasive approach, laparoscopic and robotic, in rectal resection for cancer. A single center experience. Acta Chir Iugosl. 2010;57:29–35.PubMedCrossRef

31.

deSouza AL, Prasad LM, Park JJ, et al. Robotic assistance in right hemicolectomy: is there a role? Dis Colon Rectum. 2010;53:1000–6.PubMedCrossRef

32.

Bianchi PP, Ceriani C, Locatelli A, et al. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc. 2010;24:2888–94.PubMedCrossRef

33.

Patriti A, Ceccarelli G, Bartoli A, et al. Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS. 2009;13:176–83.PubMed

34.

Spinoglio G, Summa M, Priora F, et al. Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum. 2008;51:1627–32.PubMedCrossRef

35.

Rawlings AL, Woodland JH, Vegunta RK, et al. Robotic versus laparoscopic colectomy. Surg Endosc. 2007;21:1701–8.PubMedCrossRef

36.

Woeste G, Bechstein WO, Wullstein C. Does telerobotic assistance improve laparoscopic colorectal surgery? Int J Colorectal Dis. 2005;20:253–7.PubMedCrossRef

37.

D’Annibale A, Morpurgo E, Fiscon V, et al. Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum. 2004;47:2162–8.PubMedCrossRef

38.

Delaney CP, Lynch AC, Senagore AJ, et al. Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum. 2003;46:1633–9.PubMedCrossRef

39.

Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1:144–50.PubMed

40.

Ma Y, Yang Z, Qin H, et al. A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer. Med Oncol. 2011;28:925–33.PubMedCrossRef

41.

Abraham NS, Young JM, Solomon MJ. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg. 2004;91:1111–24.PubMedCrossRef

42.

Weber PA, Merola S, Wasielewski A, et al. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum. 2002;45:1689–94.PubMedCrossRef

43.

Mirnezami AH, Mirnezami R, Venkatasubramaniam AK, et al. Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery. Colorectal Dis. 2010;12:1084–93.PubMedCrossRef

44.

Maeso S, Reza M, Mayol JA, et al. Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg. 2010;252:254–62.PubMedCrossRef

45.

Ahlering TE, Skarecky D, Lee D, et al. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol. 2003;170:1738–41.PubMedCrossRef

46.

Zorn KC, Orvieto MA, Gong EM, et al. Robotic radical prostatectomy learning curve of a fellowship-trained laparoscopic surgeon. J Endourol. 2007;21:441–7.PubMedCrossRef

47.

Barbash GI, Glied SA. New technology and health care costs—the case of robot-assisted surgery. N Engl J Med. 2010;363:701–4.PubMedCrossRef

48.

Hottenrott C. Robotic versus laparoscopic surgery for rectal cancer and cost-effectiveness analysis. Surg Endosc. 2011;25:3954–6.PubMedCrossRef

49.

Nagtegaal ID, van de Velde CJ, van der Worp E, et al; Cooperative Clinical Investigators of the Dutch Colorecal Cancer Group. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 2002;20:1729–34.PubMedCrossRef

50.

Collinson FJ, Jayne DG, Pigazzi A, et al. An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis. 2012;27:233–41.PubMedCrossRef

Title: Robot-Assisted Versus Conventional Laparoscopic Surgery for Colorectal Disease, Focusing on Rectal Cancer: A Meta-analysis
Authors: Yongzhi Yang, MS
Feng Wang, PhD
Peng Zhang, PhD
Chenzhang Shi, PhD
Yang Zou, MS
Huanlong Qin, MD
Yanlei Ma, PhD
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 12/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2429-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Robot-Assisted Versus Conventional Laparoscopic Surgery for Colorectal Disease, Focusing on Rectal Cancer: A Meta-analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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