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The risk of conversion in minimally invasive oncological abdominal surgery. Meta-analysis of randomized evidence comparing traditional laparoscopic versus robot-assisted techniques

Langenbeck's Archives of Surgery volume 406, pages 607–612 (2021)Cite this article

Abstract

Purpose

The objective of this study was to investigate the risk of conversion associated with conventional laparoscopic surgery (LAP) versus robot-assisted surgery (ROB) in patients undergoing abdominal oncological surgery. Possible differences between ROB and LAP on postoperative overall and major morbidity, operative time, and length of hospitalization were also assessed.

Methods

We included randomized controlled trials of LAP versus ROB surgery in patients with abdominal malignancy. We searched PubMed, EMBASE, and the Central registries through September 2020. Risk of bias was estimated concerning randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases.

Results

A total of 1867 patients from 12 trials were included in this review. The rate of conversion was significantly higher for LAP than for ROB patients (10 trials, 1447 participants, p = 0.03, OR = 0.56 [0.33, 0.95]). There was a nonsignificant advantage of ROB over LAP on the rate of overall postoperative morbidity (12 trials, 1867 participants, p = 0.32, OR = 0.83) and major morbidity (7 trials, 792 participants, p = 0.87, OR= 0.93). ROB was also associated with prolonged operative time and abbreviated postoperative hospitalization as compared to LAP (p = 0.002, MD = 27.87, and p = 0.04, MD = −0.57, respectively).

Conclusions

According to the available highest level of evidence, the application of ROB decreases the incidence of unplanned conversion into an open procedure as compared to standard LAP in the setting of oncological minimally invasive surgery.

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Acknowledgments

The authors want to express their deepest thanks to Professor Filippo La Torre and Professor Errico Orsi, whose illuminating mentorship taught us many things about love for our profession, incessant study, and humanity.

Data and materials availability

Data analysis available upon specific request.

Author information

Affiliations

  1. Ospedali Riuniti Marche Nord, Pesaro, Italy

    Francesco Guerra

  2. Misericordia Hospital, Grosseto, Italy

    Francesco Guerra & Giuseppe Giuliani

  3. IRCCS Regina Elena National Cancer Institute, Rome, Italy

    Diego Coletta

Authors
  1. Francesco Guerra
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  2. Giuseppe Giuliani
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  3. Diego Coletta
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Contributions

Study conception and design: Francesco Guerra, Diego Coletta. Acquisition of data: Francesco Guerra, Diego Coletta, Giuseppe Giuliani

Analysis and interpretation of data: Francesco Guerra, Diego Coletta. Drafting of manuscript: Francesco Guerra, Diego Coletta. Critical revision of manuscript: all authors. Approval of the final version of manuscript: all authors

Corresponding author

Correspondence to Francesco Guerra.

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The present analysis investigates the results of already published reports.

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The authors declare no conflict of interest.

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Supplementary Information

Table S1

Population, intervention, comparator, outcome, and study design (PICOS) criteria (DOCX 828 kb)

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Guerra, F., Giuliani, G. & Coletta, D. The risk of conversion in minimally invasive oncological abdominal surgery. Meta-analysis of randomized evidence comparing traditional laparoscopic versus robot-assisted techniques. Langenbecks Arch Surg 406, 607–612 (2021). https://doi.org/10.1007/s00423-021-02106-y

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  • DOI: https://doi.org/10.1007/s00423-021-02106-y

Keywords

  • Minimally invasive surgery; Robot-assisted surgery; Surgical oncology; Conversion