达芬奇机器人与腹腔镜胃癌手术安全性与可行性对比的meta分析
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摘要
目的:系统性评价机器人胃切除术与腹腔镜胃切除术的近期临床疗效及安全性。方法:计算机检索中国知网(CNKI)、万方数据库、中国生物医学文献数据库(CBM)、PubMed、Web of Science、Embase及Cochrane Library等医学数据库,收集2015年1月至2018年7月公开发表的比较机器人胃切除术与腹腔镜胃切除术治疗胃癌疗效与安全性的中、英文文献,按纳入标准、排除标准进行筛选,采用Review Manager 5.3软件进行meta分析。结果:共18项研究涉及6 644例患者符合标准。其中机器人组2 028例,腹腔镜组4 616例。与腹腔镜胃切除术相比,机器人胃切除术手术时间更长[WMD(95%CI):44.20(29.36～59.04),P<0.01],但术中出血量更少[WMD(95%CI):-24.05(-33.21～-14.89),P<0.01],清扫淋巴结数量更多[WMD(95%CI):3.17(1.53～4.81),P<0.01],术后通气时间、进食时间及住院时间更短[WMD(95%CI):-0.21(-0.37～-0.04),P<0.05; WMD(95%CI):-0.26(-0.51～-0.01),P<0.05; WMD(95%CI):-0.72(-1.11～-0.34),P<0.05],术后总并发症更少[OR(95%CI):0.71(0.55～0.92),P<0.05],近端切缘长度、远端切缘长度等差异无统计学意义[WMD(95%CI):-0.03(-0.16～0.10),P=0.63; WMD(95%CI):0.00(-0.18～0.19),P=0.96]。结论:机器人胃切除术在技术上是安全、可行的,相较腹腔镜胃切除术具有更多优势,在降低手术成本、缩短手术时间的基础上可广泛推广。
Objective: To systematically evaluate the recent clinical efficacy and safety of robotic gastrectomy( RG) and laparoscopic gastrectomy( LG).Methods: Medical databases such as China National Knowledge Infrastructure( CNKI),Wanfang Database,Chinese Biomedical Literature Database( CBM),PubMed,Web of Science,Embase and Cochrane Library were searched,and Chinese and English literatures on the efficacy and safety of RG and LG in the treatment of gastric cancer published from January 2015 to July2018 were screened according to inclusion criteria and exclusion criteria,and meta-analysis was performed using Review Manager 5.3 software.Results: A total of 18 studies involving 6 644 patients,including 2 028 robotic surgery patients and 4 616 laparoscopic surgery patients,met the criteria.Compared with LG group,RG group had longer operation time [WMD( 95% CI) : 44.20( 29.36 ～ 59.04),P<0.01],but less blood loss during surgery [WMD( 95% CI) :-24. 05(-33. 21 ～-14. 89),P < 0. 01],more lymph nodes were removed[WMD( 95% CI) : 3.17( 1.53～4.81),P<0.01],postoperative ventilation time,eating time and hospital stay were shorter [WMD( 95%CI) :-0.21(-0. 37 ～-0. 04),P < 0. 05; WMD( 95% CI) :-0. 26(-0. 51 ～-0. 01),P < 0. 05; WMD( 95% CI) :-0. 72(-1. 11 ～-0. 34),P <0.05],the total postoperative complications were less [OR( 95% CI) : 0.71( 0.55 ～ 0.92),P<0.05].There was no significant difference in length of the proximal resection margin and the distal resection margin [WMD( 95% CI) :-0.03(-0.16 ～ 0.10),P = 0.63; WMD( 95%CI) : 0.00(-0.18 ～ 0.19),P = 0.96].Conclusions: RG is technically safe and feasible.It has more advantages than LG and can be widely promoted on the basis of reducing the cost of surgery and shortening the operation time.
Objective: To systematically evaluate the recent clinical efficacy and safety of robotic gastrectomy( RG) and laparoscopic gastrectomy( LG).Methods: Medical databases such as China National Knowledge Infrastructure( CNKI),Wanfang Database,Chinese Biomedical Literature Database( CBM),PubMed,Web of Science,Embase and Cochrane Library were searched,and Chinese and English literatures on the efficacy and safety of RG and LG in the treatment of gastric cancer published from January 2015 to July2018 were screened according to inclusion criteria and exclusion criteria,and meta-analysis was performed using Review Manager 5.3 software.Results: A total of 18 studies involving 6 644 patients,including 2 028 robotic surgery patients and 4 616 laparoscopic surgery patients,met the criteria.Compared with LG group,RG group had longer operation time [WMD( 95% CI) : 44.20( 29.36 ～ 59.04),P<0.01],but less blood loss during surgery [WMD( 95% CI) :-24. 05(-33. 21 ～-14. 89),P < 0. 01],more lymph nodes were removed[WMD( 95% CI) : 3.17( 1.53～4.81),P<0.01],postoperative ventilation time,eating time and hospital stay were shorter [WMD( 95%CI) :-0.21(-0. 37 ～-0. 04),P < 0. 05; WMD( 95% CI) :-0. 26(-0. 51 ～-0. 01),P < 0. 05; WMD( 95% CI) :-0. 72(-1. 11 ～-0. 34),P <0.05],the total postoperative complications were less [OR( 95% CI) : 0.71( 0.55 ～ 0.92),P<0.05].There was no significant difference in length of the proximal resection margin and the distal resection margin [WMD( 95% CI) :-0.03(-0.16 ～ 0.10),P = 0.63; WMD( 95%CI) : 0.00(-0.18 ～ 0.19),P = 0.96].Conclusions: RG is technically safe and feasible.It has more advantages than LG and can be widely promoted on the basis of reducing the cost of surgery and shortening the operation time.
引文
[1]Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[S].CA Cancer J Clin,2015,65(2):87-108.
[2]Chen K,Wu D,Pan Y,et al.Totally laparoscopic gastrectomy using intracorporeally stapler or hand-sewn anastomosis for gastric cancer:a single-center experience of 478 consecutive cases and outcomes[J].World J Surg Oncol,2016,14:115.
[3]Vi1uela EF,Gonen M,Brennan MF,et al.Laparoscopic versus open distal gastrectomy for gastric cancer:a meta-analysis of randomized controlled trials and high-quality nonrandomized studies[J].Ann Surg,2012,255(3):446-456.
[4]Giulianotti PC,Coratti A,Angelini M,et al.Robotics in general surgery:personal experience in a large community hospital[J].Arch Surg,2003,138(7):777-784.
[5]Cianchi F,Indennitate G,Trallori G,et al.Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer:a retrospective comparative mono-institutional study[J].BMC Surg,2016,16(1):65.
[6]Kim YW,Reim D,Park JY,et al.Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer[J].Surg Endosc,2016,30(4):1547-1552.
[7]Lee J,Kim YM,Woo Y,et al.Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index:comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy[J].Surg Endosc,2015,29(11):3251-3260.
[8]Obama K,Kim YM,Kang DR,et al.Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy[J].Gastric Cancer,2018,21(2):285-295.
[9]Okumura N,Son T,Kim YM,et al.Robotic gastrectomy for elderly gastric cancer patients:comparisons with robotic gastrectomy in younger patients and laparoscopic gastrectomy in the elderly[J].Gastric Cancer,2016,19(4):1125-1134.
[10]Parisi A,Reim D,Borghi F,et al.Minimally invasive surgery for gastric cancer:A comparison between robotic,laparoscopic and open surgery[J].World J Gastroenterol,2017,23(13):2376-2384.
[11]Park JY,Ryu KW,Reim D,et al.Robot-assisted gastrectomy for early gastric cancer:is it beneficial in viscerally obese patients compared to laparoscopic gastrectomy?[J].World J Surg,2015,39(7):1789-1797.
[12]Shen W,Xi H,Wei B,et al.Robotic versus laparoscopic gastrectomy for gastric cancer:comparison of short-term surgical outcomes[J].Surg Endosc,2016,30(2):574-580.
[13]Yang SY,Roh KH,Kim YN,et al.Surgical Outcomes After Open,Laparoscopic,and Robotic Gastrectomy for Gastric Cancer[J].Ann Surg Oncol,2017,24(7):1770-1777.
[14]胡时栋,胡子龙,邹贵军,等.达芬奇机器人与腹腔镜辅助胃癌根治术近期疗效的对比研究[J].中国临床研究,2017,30(6):721-724.
[15]蓝炘,郗洪庆,张珂诚,等.开放和腹腔镜及机器人胃癌根治术后并发症发生情况的对比分析[J].中华胃肠外科杂志,2017,20(2):184-189.
[16]李盖天,陈鹏,徐麟,等.达芬奇机器人与腹腔镜根治性全胃切除术的近期疗效对比[J].腹腔镜外科杂志,2017,22(10):721-725.
[17]李鹏,李冰,刘洪一,等.达芬奇机器人手术系统在胃癌中的应用[J].临床与病理杂志,2015,35(6):1103-1106.
[18]李松岩,宋林杰,那兴邦,等.达芬奇机器人手术系统与腹腔镜辅助远端胃癌D2根治BillrothⅠ吻合术治疗胃癌效果比较[J].中华实用诊断与治疗杂志,2018,32(3):245-247.
[19]滕达,李松岩,胡时栋,等.达芬奇机器人与腹腔镜远端胃癌根治术的近期疗效比较[J].解放军医学院学报,2017,38(12):1095-1097.
[20]王玲的,胡时栋,马跃,等.腹腔镜辅助与开腹胃癌根治术的短期临床效果比较[J].解放军医学院学报,2016,37(6):541-543.
[21]薛勇敢,张秉栋,张加金,等.机器人手术治疗进展期胃癌的临床价值分析[J].腹部外科,2016,29(1):8-12.
[22]周峻峰.达芬奇机器人胃癌手术后并发症的分级评估及危险因素的临床研究[D].重庆:第三军医大学,2015.
[23]Eom BW,Yoon HM,Ryu KW,et al.Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer[J].Eur J Surg Oncol,2012,38(1):57-63.
[24]Kang BH,Xuan Y,Hur H,et al.Comparison of Surgical Outcomes between Robotic and Laparoscopic Gastrectomy for Gastric Cancer:The Learning Curve of Robotic Surgery[J].J Gastric Cancer,2012,12(3):156-163.
[25]Kim MC,Kim KH,Kim HH,et al.Comparison of laparoscopy-assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer[J].J Surg Oncol,2005,91(1):90-94.
[26]余佩武,郝迎学.机器人优于2D和3D腹腔镜[J].中华胃肠外科杂志,2015,18(8):767-768.
[2]Chen K,Wu D,Pan Y,et al.Totally laparoscopic gastrectomy using intracorporeally stapler or hand-sewn anastomosis for gastric cancer:a single-center experience of 478 consecutive cases and outcomes[J].World J Surg Oncol,2016,14:115.
[3]Vi1uela EF,Gonen M,Brennan MF,et al.Laparoscopic versus open distal gastrectomy for gastric cancer:a meta-analysis of randomized controlled trials and high-quality nonrandomized studies[J].Ann Surg,2012,255(3):446-456.
[4]Giulianotti PC,Coratti A,Angelini M,et al.Robotics in general surgery:personal experience in a large community hospital[J].Arch Surg,2003,138(7):777-784.
[5]Cianchi F,Indennitate G,Trallori G,et al.Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer:a retrospective comparative mono-institutional study[J].BMC Surg,2016,16(1):65.
[6]Kim YW,Reim D,Park JY,et al.Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer[J].Surg Endosc,2016,30(4):1547-1552.
[7]Lee J,Kim YM,Woo Y,et al.Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index:comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy[J].Surg Endosc,2015,29(11):3251-3260.
[8]Obama K,Kim YM,Kang DR,et al.Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy[J].Gastric Cancer,2018,21(2):285-295.
[9]Okumura N,Son T,Kim YM,et al.Robotic gastrectomy for elderly gastric cancer patients:comparisons with robotic gastrectomy in younger patients and laparoscopic gastrectomy in the elderly[J].Gastric Cancer,2016,19(4):1125-1134.
[10]Parisi A,Reim D,Borghi F,et al.Minimally invasive surgery for gastric cancer:A comparison between robotic,laparoscopic and open surgery[J].World J Gastroenterol,2017,23(13):2376-2384.
[11]Park JY,Ryu KW,Reim D,et al.Robot-assisted gastrectomy for early gastric cancer:is it beneficial in viscerally obese patients compared to laparoscopic gastrectomy?[J].World J Surg,2015,39(7):1789-1797.
[12]Shen W,Xi H,Wei B,et al.Robotic versus laparoscopic gastrectomy for gastric cancer:comparison of short-term surgical outcomes[J].Surg Endosc,2016,30(2):574-580.
[13]Yang SY,Roh KH,Kim YN,et al.Surgical Outcomes After Open,Laparoscopic,and Robotic Gastrectomy for Gastric Cancer[J].Ann Surg Oncol,2017,24(7):1770-1777.
[14]胡时栋,胡子龙,邹贵军,等.达芬奇机器人与腹腔镜辅助胃癌根治术近期疗效的对比研究[J].中国临床研究,2017,30(6):721-724.
[15]蓝炘,郗洪庆,张珂诚,等.开放和腹腔镜及机器人胃癌根治术后并发症发生情况的对比分析[J].中华胃肠外科杂志,2017,20(2):184-189.
[16]李盖天,陈鹏,徐麟,等.达芬奇机器人与腹腔镜根治性全胃切除术的近期疗效对比[J].腹腔镜外科杂志,2017,22(10):721-725.
[17]李鹏,李冰,刘洪一,等.达芬奇机器人手术系统在胃癌中的应用[J].临床与病理杂志,2015,35(6):1103-1106.
[18]李松岩,宋林杰,那兴邦,等.达芬奇机器人手术系统与腹腔镜辅助远端胃癌D2根治BillrothⅠ吻合术治疗胃癌效果比较[J].中华实用诊断与治疗杂志,2018,32(3):245-247.
[19]滕达,李松岩,胡时栋,等.达芬奇机器人与腹腔镜远端胃癌根治术的近期疗效比较[J].解放军医学院学报,2017,38(12):1095-1097.
[20]王玲的,胡时栋,马跃,等.腹腔镜辅助与开腹胃癌根治术的短期临床效果比较[J].解放军医学院学报,2016,37(6):541-543.
[21]薛勇敢,张秉栋,张加金,等.机器人手术治疗进展期胃癌的临床价值分析[J].腹部外科,2016,29(1):8-12.
[22]周峻峰.达芬奇机器人胃癌手术后并发症的分级评估及危险因素的临床研究[D].重庆:第三军医大学,2015.
[23]Eom BW,Yoon HM,Ryu KW,et al.Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer[J].Eur J Surg Oncol,2012,38(1):57-63.
[24]Kang BH,Xuan Y,Hur H,et al.Comparison of Surgical Outcomes between Robotic and Laparoscopic Gastrectomy for Gastric Cancer:The Learning Curve of Robotic Surgery[J].J Gastric Cancer,2012,12(3):156-163.
[25]Kim MC,Kim KH,Kim HH,et al.Comparison of laparoscopy-assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer[J].J Surg Oncol,2005,91(1):90-94.
[26]余佩武,郝迎学.机器人优于2D和3D腹腔镜[J].中华胃肠外科杂志,2015,18(8):767-768.