P Gavriilidis1, J Wheeler2, A Spinelli3,4, N de'Angelis5,6, C Simopoulos7, S Di Saverio2,8. 1. Division of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK. 2. Colorectal Surgery Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK. 3. Department of Biomedical Sciences, Humanitas University, Rozzano Milano, Italy. 4. Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano Milano, Italy. 5. Department of Digestive Surgery, AP-HP, University Hospital Henri Mondor, Créteil, France. 6. University Paris Est, Créteil, France. 7. 2nd Department of Surgery, Medical School, Democritus University of Thrace, Alexandroupolis, Greece. 8. Department of General Surgery, ASST Sette Laghi, University of Insubria, University Hospital of Varese, Regione Lombardia, Italy.
Abstract
AIM: The debate about the oncological adequacy, safety and efficiency of robotic vs laparoscopic total mesorectal excision for rectal cancers continues. Therefore, an updated, traditional and cumulative meta-analysis was performed with the aim of assessing the new evidence on this topic. METHOD: A systematic search of the literature for data pertaining to the last 25 years was performed. Fixed- and random-effects models were used to cumulatively assess the accumulation of evidence over time. RESULTS: Patients with a significantly higher body mass index (BMI), tumours located approximately 1 cm further distally and more patients undergoing neoadjuvant therapy were included in the robotic total mesorectal excision (RTME) cohort compared with those in the laparoscopic total mesorectal excision (LTME) cohort [RTME, mean difference (MD) = 0.22 (0.07, 0.36), P = 0.005; LTME, MD = -0.97 (-1.57, 0.36), P < 0.002; OR = 1.47 (1.11, 1.93), P = 0.006]. Significantly lower conversion rates to open surgery were observed in the RTME cohort than in the LTME cohort [OR = 0.33 (0.24, 0.46), P < 0.001]. Operative time in the LTME cohort was significantly reduced (by 50 min) compared with the RTME cohort. Subgroup analysis of the three randomized controlled trials (RCTs) challenged all the significant results of the main analysis and demonstrated nonsignificant differences between the RTME cohort and LTME cohort. CONCLUSION: Although the RTME cohort included patients with a significantly higher BMI, more distal tumours and more patients undergoing neoadjuvant therapy, this cohort demonstrated lower conversion rates to open surgery when compared with the LTME cohort. However, subgroup analysis of the RCTs demonstrated nonsignificant differences between the two procedures.
AIM: The debate about the oncological adequacy, safety and efficiency of robotic vs laparoscopic total mesorectal excision for rectal cancers continues. Therefore, an updated, traditional and cumulative meta-analysis was performed with the aim of assessing the new evidence on this topic. METHOD: A systematic search of the literature for data pertaining to the last 25 years was performed. Fixed- and random-effects models were used to cumulatively assess the accumulation of evidence over time. RESULTS:Patients with a significantly higher body mass index (BMI), tumours located approximately 1 cm further distally and more patients undergoing neoadjuvant therapy were included in the robotic total mesorectal excision (RTME) cohort compared with those in the laparoscopic total mesorectal excision (LTME) cohort [RTME, mean difference (MD) = 0.22 (0.07, 0.36), P = 0.005; LTME, MD = -0.97 (-1.57, 0.36), P < 0.002; OR = 1.47 (1.11, 1.93), P = 0.006]. Significantly lower conversion rates to open surgery were observed in the RTME cohort than in the LTME cohort [OR = 0.33 (0.24, 0.46), P < 0.001]. Operative time in the LTME cohort was significantly reduced (by 50 min) compared with the RTME cohort. Subgroup analysis of the three randomized controlled trials (RCTs) challenged all the significant results of the main analysis and demonstrated nonsignificant differences between the RTME cohort and LTME cohort. CONCLUSION: Although the RTME cohort included patients with a significantly higher BMI, more distal tumours and more patients undergoing neoadjuvant therapy, this cohort demonstrated lower conversion rates to open surgery when compared with the LTME cohort. However, subgroup analysis of the RCTs demonstrated nonsignificant differences between the two procedures.
Authors: Mauro Podda; Patricia Sylla; Gianluca Baiocchi; Michel Adamina; Vanni Agnoletti; Ferdinando Agresta; Luca Ansaloni; Alberto Arezzo; Nicola Avenia; Walter Biffl; Antonio Biondi; Simona Bui; Fabio C Campanile; Paolo Carcoforo; Claudia Commisso; Antonio Crucitti; Nicola De'Angelis; Gian Luigi De'Angelis; Massimo De Filippo; Belinda De Simone; Salomone Di Saverio; Giorgio Ercolani; Gustavo P Fraga; Francesco Gabrielli; Federica Gaiani; Mario Guerrieri; Angelo Guttadauro; Yoram Kluger; Ari K Leppaniemi; Andrea Loffredo; Tiziana Meschi; Ernest E Moore; Monica Ortenzi; Francesco Pata; Dario Parini; Adolfo Pisanu; Gilberto Poggioli; Andrea Polistena; Alessandro Puzziello; Fabio Rondelli; Massimo Sartelli; Neil Smart; Michael E Sugrue; Patricia Tejedor; Marco Vacante; Federico Coccolini; Justin Davies; Fausto Catena Journal: World J Emerg Surg Date: 2021-07-02 Impact factor: 5.469
Authors: Julie Flynn; Jose T Larach; Joseph C H Kong; Satish K Warrier; Alexander Heriot Journal: Int J Colorectal Dis Date: 2021-03-15 Impact factor: 2.571
Authors: Marco Milone; Michele Manigrasso; Pietro Anoldo; Anna D'Amore; Ugo Elmore; Mariano Cesare Giglio; Gianluca Rompianesi; Sara Vertaldi; Roberto Ivan Troisi; Nader K Francis; Giovanni Domenico De Palma Journal: J Pers Med Date: 2022-02-18