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Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies

  • K. Phan
  • H. R. Kahlaee
  • S. H. Kim
  • J. W. T. TohEmail author
Review Article

Abstract

Background

The usage of robotic surgery in rectal cancer is increasing, but there is an ongoing debate as to whether it provides any benefit. The aim of the present study was to determine if robotic surgery results in less conversion to an open operation than laparoscopic rectal cancer surgery.

Methods

A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club and Database of Abstracts of Review of Effectiveness. Included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies comparing a robotic vs. laparoscopic approach to rectal cancer surgery. The primary endpoint was conversion to open. All statistical analyses and data synthesis were conducted using STATA/IC version 14·2, Windows 64 bit (StataCorp LP, College Station, TX, USA)

Results

Six hundred and twenty-one studies were identified through electronic database search. After application of selection criteria as per PRISMA and MOOSE criteria, six RCTs and five PSM articles were analyzed. From the six RCTs, 512 robotic and 519 laparoscopic cases were evaluated. There was a significantly lower rate of conversion for the robotic surgery arm (4.1% vs. 8.1%, OR 0.28; 95% CI 0.00–0.57). Of the five PSM studies, 2097 robotic and 3053 laparoscopic cases were evaluated. There was a significantly lower conversion to open rate found in the robotic surgery cohort (7.4% vs. 15.6%; OR 0.39; 95% CI 0.30–0.47). Pooled RCT and PSM data demonstrated significantly lower conversion rates for robotic surgery (6.7% vs. 14.5%; OR 0.38; 95% CI 0.30–0.46).

Conclusions

Robotic surgery for rectal cancer is associated with reduced conversion to open surgery compared to a laparoscopic approach.

Keywords

Robotic surgical procedures Laparoscopic surgery RECTUM/surg Rectal cancer Conversion to open surgery Meta-analysis 

Notes

Acknowledgements

Dr James W. T. Toh received the Morgan Fellowship from the Royal Australasian College of Surgeons to conduct his international robotic fellowship in Korea.

Author contributions

Conception and design: KP and JWTT conceived the study and contributed equally, and all authors substantially contributed to the design of the study. Analysis and interpretation of the data: KP, JWTT, and HRK were involved in the analyses and substantially contributed to interpretation of the data. Drafting of the article: KP and JWTT contributed to the first draft of the manuscript. All authors provided substantial contribution to the critical revisions of the manuscript. Collection and assembly of data: KP and JWTT were responsible for the data, and KP, JWTT, and HRK performed the data analysis with the other authors assisting in the interpretation. All authors take responsibility for the integrity of the data and the accuracy of the data analysis. All of the authors were significantly involved in this work and provided final approval of the submitted manuscript.

Funding

Nil funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The authors have complied with appropriate ethical standards in preparation and publication of this manuscript.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

10151_2018_1920_MOESM1_ESM.docx (317 kb)
Supplementary material 1 (DOCX 316 KB)
10151_2018_1920_MOESM2_ESM.doc (62 kb)
Supplementary material 2 (DOC 62 KB)
10151_2018_1920_MOESM3_ESM.docx (30 kb)
Supplementary material 3 (DOCX 30 KB)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • K. Phan
    • 1
    • 2
    • 3
  • H. R. Kahlaee
    • 4
  • S. H. Kim
    • 5
  • J. W. T. Toh
    • 1
    • 2
    Email author
  1. 1.Division of Colorectal Surgery, Department of SurgeryWestmead HospitalSydneyAustralia
  2. 2.The University of Sydney, Westmead Clinical SchoolSydneyAustralia
  3. 3.Division of Colorectal Surgery, Department of SurgeryLiverpool HospitalLiverpoolAustralia
  4. 4.Department of Pharmacy, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
  5. 5.Division of Colorectal Surgery, Department of SurgeryKorea University Anam Hospital, Korea University College of MedicineSeoulSouth Korea

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