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The impact of robotic colorectal surgery in obese patients: a systematic review, meta-analysis, and meta-regression

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Abstract

Background

Robotic surgery (RS) may overcome the limitations of laparoscopic colorectal surgeries (LS) in obese patients, but remains less well studied. This systematic review and meta-analysis aims to evaluate the outcomes of obese patients who have undergone robotic colorectal surgery.

Methods

This study was performed according to the PRISMA guidelines. A search was performed on Medline, EMBASE, and the Cochrane Library to identify relevant articles. Dichotomous and continuous outcomes were analyzed as risk ratio (RR) and mean difference (MD), respectively. All post-operative outcomes were within 30 days after surgery. The quality of studies was assessed using the Newcastle–Ottawa Scale. Meta-regression analysis was conducted to identify sources of heterogeneity.

Results

Three studies totaling 262 subjects compared LS (45.0%) against RS (55.0%) in obese patients. The RS group had a significantly reduced length of hospital stay (LOS) (MD − 2.55 days, 95%CI − 3.13 to − 1.97 days, P < 0.00001, I2 = 26%) and lower risk of re-admission (RR 0.42, 95%CI 0.19–0.92, P = 0.030, I2 = 0%), however, the length of operative time was longer (MD 40.54 min, 95%CI 32.72–48.36 min, P < 0.00001, I2 = 37%). Six studies totaling 761 subjects compared obese (40.5%) against non-obese (59.5%) patients who underwent RS. An increased operative time (MD 20.72 min, 95%CI 7.39–34.04 min, P = 0.002, I2 = 0%) and risk of wound infection (RR 2.59, 95%CI 1.12–6.02, P = 0.030, I2 = 0%) were noted in the former, with no differences in other intra- and post-operative outcomes. Meta-regression revealed that the pathology (rectal, colon, both) (P = 0.255), age (P = 0.530), gender (P = 0.279), and continent that the study originated from (P = 0.583) were not significant sources of heterogeneity for the risk of wound infection.

Conclusion

Compared to laparoscopy, robotic surgery provides earlier recovery with shorter LOS and reduced re-admission rates for obese patients, without compromising on other operative outcomes. Among patients undergoing robotic colorectal surgery, obesity is associated with a longer operative duration and greater risk of wound infection.

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Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Ian Jun Yan Wee

  2. Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan

    Li-Jen Kuo

  3. Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore

    James Chi-Yong Ngu

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  1. Ian Jun Yan Wee
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Correspondence to James Chi-Yong Ngu.

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Ian Jun Yan Wee, Li-Jen Kuo, and James Chi-Yong Ngu have no conflicts of interest or financial ties to disclose.

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Wee, I.J.Y., Kuo, LJ. & Ngu, J.CY. The impact of robotic colorectal surgery in obese patients: a systematic review, meta-analysis, and meta-regression. Surg Endosc 33, 3558–3566 (2019). https://doi.org/10.1007/s00464-019-07000-9

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  • DOI: https://doi.org/10.1007/s00464-019-07000-9

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