Laparoscopic versus robotic-assisted colectomy and rectal resection: a systematic review and meta-analysis
- 984 Downloads
Lately, the main technical innovations in the field of colorectal surgery have been the introduction of laparoscopic and robotic techniques; the aim of this study is to investigate the results and the advantages of these two surgical approaches.
Twenty-two studies including 1652 laparoscopic and 1120 robotic-assisted resections were analyzed and categorized into right, left, and pelvic resections of the middle/low rectum, aiming to the following outcomes: operating time, blood loss, bowel function recovery, return to oral intake, morbidity, hospital stay, and costs.
The vast majority of the studies were non-randomized investigations (19/22 studies) enrolling small cohorts of patients (median 55.0 laparoscopic and 34.5 robotic-assisted group) with a mean age of 62.2–61.0 years. Funnel plot analysis documented heterogeneity in studies which combined cancers and benign diseases.
Our meta-analysis demonstrated a significant difference in favor of laparoscopic procedures regarding costs and operating time (standardized mean difference (SMD) 0.686 and 0.493) and in favor of robotic surgery concerning morbidity rate (odds ratio (OR) 0.763), although no benefits were documented when analyzing exclusively randomized trials. When we differentiated approaches by side of resections, a significant difference was found in favor of the laparoscopic group when analyzing operating time in left-sided and pelvic procedures (SMD 0.609 and 0.529) and blood loss in pelvic resections (SMD 0.339).
Laparoscopic techniques were documented as the shorter procedures, which provided lower blood loss in pelvic resections, while morbidity rate was more favorable in robotic surgery. However, these results could not be confirmed when we focused the analysis on randomized trials only.
KeywordsColorectal cancer Laparoscopy Robotic surgery Meta-analysis
The authors thank Mr. Michael Gerald Kenyon for his help in editing the manuscript.
Conflict of interest
None of the authors has any potential financial conflict of interest related to this manuscript.
- 1.National Comprehensive Cancer Network, NCCN Guidelines – Colon cancer, version 1.2013. www.nccn.org.
- 10.Lorenzon L, La Torre M, Ziparo V, Montebelli F, Mercantini P, Balducci G, Ferri M (2014) Evidence based medicine and surgical approaches for colon cancer: evidences, benefits and limitations of the laparoscopic vs open resection. World J Gastroenterol 20(13):3680–3692PubMedCentralCrossRefPubMedGoogle Scholar
- 16.Lim DR, Min BS, Kim MS, Alasari S, Kim G, Hur H, Baik SH, Lee KY, Kim NK (2013) Robotic versus laparoscopic anterior resection of sigmoid colon cancer: comparative study of long-term oncologic outcomes. Surg Endosc 27(4):1379–1385. doi: 10.1007/s00464-012-2619-3 PubMedCentralCrossRefPubMedGoogle Scholar
- 22.Bertani E, Chiappa A, Biffi R, Bianchi PP, Radice D, Branchi V, Cenderelli E, Vetrano I, Cenciarelli S, Andreoni B (2011) Assessing appropriateness for elective colorectal cancer surgery: clinical, oncological, and quality-of-life short-term outcomes employing different treatment approaches. Int J Color Dis 26(10):1317–1327CrossRefGoogle Scholar
- 25.Bianchi PP, Ceriani C, Locatelli A, Spinoglio G, Zampino MG, Sonzogni A, Crosta C, Andreoni B (2010) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc 24(11):2888–2894. doi: 10.1007/s00464-010-1134-7 CrossRefPubMedGoogle Scholar
- 34.Erguner I, Aytac E, Boler DE, Atalar B, Baca B, Karahasanoglu T, Hamzaoglu I, Uras C (2013) What have we gained by performing robotic rectal resection? Evaluation of 64 consecutive patients who underwent laparoscopic or robotic low anterior resection for rectal adenocarcinoma. Surg Laparosc Endosc Percutan Tech 23(3):316–319CrossRefPubMedGoogle Scholar
- 36.Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, Carpenter J, Rücker G, Harbord RM, Schmid CH, Tetzlaff J, Deeks JJ, Peters J, Macaskill P, Schwarzer G, Duval S, Altman DG, Moher D, Higgins JP (2011) Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 343:d4002CrossRefPubMedGoogle Scholar
- 41.Collinson FJ, Jayne DG, Pigazzi A, Tsang C, Barrie JM, Edlin R, Garbett C, Guillou P, Holloway I, Howard H, Marshall H, McCabe C, Pavitt S, Quirke P, Rivers CS, Brown JM (2012) 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 Color Dis 27(2):233–241CrossRefGoogle Scholar