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Meta-analysis and trial sequential analysis of robotic versus laparoscopic total mesorectal excision in management of rectal cancer

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Abstract

Background

We aimed to evaluate comparative outcomes of robotic and laparoscopic total mesorectal excision (TME) in patients with rectal cancer.

Methods

We systematically searched electronic data sources with application of combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators, and limits. Perioperative clinical and short-term oncological outcomes were evaluated. Trial Sequential Analysis of the outcomes was conducted.

Results

Nine randomised-controlled trials reporting 1463 patients evaluating outcomes of robotic TME (n = 728) and laparoscopic TME (n = 735) were included. Although the robotic approach was associated with significantly longer operative time (MD 31.64, P = 0.002), it was associated with significantly longer DRM (MD 0.8, P = 0.004) and shorter time to soft diet (MD − 0.50, P = 0.03) compared to the laparoscopic approach. Moreover, there was no significant difference in intraoperative (RR 1.07, P = 0.76)) and postoperative (RR 0.97, P = 0.81) complications, anastomotic leak (RR 0.93, P = 0.69), conversion to open rate (RR 0.46, P = 0.05), blood loss (MD 19.65, P = 0.74), time to first flatus (MD − 0.30, P = 0.37), LARS (RR 0.83, P = 0.41), ileus (RR 0.72, P = 0.39), positive CRM (RR 0.82, P = 0.49), PRM (MD − 0.5, P = 0.55), number of harvested lymph nodes (MD 0.33, P = 0.58), or length of stay (MD − 0.60, P = 0.12) between two groups. The Trial Sequential Analysis demonstrated that the risk of type 1 and type 2 errors was minimal in most outcomes.

Conclusions

Moderate-quality evidence suggested that robotic and laparoscopic TME may be comparable in terms of clinical and short-term oncological profile but the robotic approach may be associated with longer procedure time. Future high-quality randomised studies are encouraged to compare the functional, long-term oncological, and cost-effectiveness outcomes of both approaches.

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Availability of data and material

We declare that this manuscript of meta-analysis and trial sequential analysis is original, has not been published before, and is not currently being considered for publication elsewhere. We confirm that the paper is not based on previous communication to a society or meeting.

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Author notes

  1. Mokhtar Eltair, Shahin Hajibandeh and Shahab Hajibandeh equally contributed to this paper and joined first authorship is proposed.

Authors and Affiliations

  1. Department of Colorectal Surgery, Ealing Hospital, North West London Hospitals NHS Trust, London, UK

    Mokhtar Eltair, Abdirahaman Nuno, Kadhim Hussein Abdullah, Ashish Sinha & Tushar Agarwal

  2. Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK

    Shahin Hajibandeh & Ahmad Alkaili-Alyamani

  3. Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, UK

    Shahab Hajibandeh

  4. Department of Colorectal Surgery, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwickshire, UK

    Muhammad Imran Aslam

Authors
  1. Mokhtar Eltair
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  4. Abdirahaman Nuno
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Contributions

Conception and design: Mokhtar E, Shahin H

Literature search and study selection: Mokhtar E, Shahin H, Shahab H

Data collection: Mokhtar E, Shahin H, Shahab H

Analysis and interpretation: Mokhtar E, Shahin H, Shahab H

Writing the article: Mokhtar E, Shahin H, Shahab H

Critical revision of the article: All authors

Final approval of the article: All authors

Corresponding author

Correspondence to Mokhtar Eltair.

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The authors declare that there are no conflicts of interest.

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Appendix

Appendix

Table 3 Our search strategy was adapted according to thesaurus headings, search operators, and limits in the aforementioned databases
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Eltair, M., Hajibandeh, S., Hajibandeh, S. et al. Meta-analysis and trial sequential analysis of robotic versus laparoscopic total mesorectal excision in management of rectal cancer. Int J Colorectal Dis 35, 1423–1438 (2020). https://doi.org/10.1007/s00384-020-03655-2

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