Advantages of robotic right colectomy over laparoscopic right colectomy beyond the learning curve: a systematic review and meta-analysis

摘要

Background: With the widespread application of robotic systems and the increasing number of studies comparing robotic right colectomy (RRC) and laparoscopic right colectomy (LRC), there is a need for an up-to-date systemic review and meta-analysis assessing the advantages of this technique. Methods: The systemic review was performed in Medline, Scopus, Embase, Cochrane Oral Health Group Specialized Register and Google Scholar databases searching for studies comparing RRC and LRC, with no date restriction but limited to English and French literature. Two independent reviewers performed data extraction and qualitative synthesis. Random-effects models were used to summarize the risk ratio (RR) and mean differences (MD) with 95% confidence interval (CI). Results: Twenty-six non-randomized clinical trials (NRCTs) and 1 RCT were included. Overall, 2,314 patients underwent RRC and 17,791 LRC. Operative time was significantly longer for RRC with a MD of 45.36 min (95% CI: 31.75-58.97; P<0.00001). Conversion rate was significantly lower in the RRC group with a RR of 0.47 (95% CI: 0.27-0.81; P=0.007, I-2=33%). Also, the number of harvested lymph node was significantly higher in the RRC group than the LRC group, with a MD of 2.03 (95% CI: 0.45-3.61; P=0.01, I-2=68%). Estimated blood loss favored RRC, with a MD of-8.68 (95% CI:-17.27 to-0.08; P=0.05, I-2=46%). There was no difference in the overall complication rate, mortality, anastomotic leakage, and time to first flatus. However, a significantly shorter hospital stay was associated with RRC, with a MD of -0.60 (95% CI:-1.01 to-0.19; P=0.004, I-2=64%). No quantitative analysis could be performed for oncological outcomes. RRC was associated with significantly higher costs (MD 3,185.50 USD; 95% CI: 720.98-5650.02; P=0.01, I-2=94%). Conclusions: RRC is a safe procedure that may offer certain advantages over LRC as lower conversion rate, blood loss, hospital stay. However, this should be balanced out with increased operative time and higher costs.