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Robotic versus laparoscopic surgery for rectal cancer: an overview of systematic reviews with quality assessment of current evidence

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Abstract

Purpose

The clinical benefits of robotic surgery for patients with rectal cancer have been reported and many systematic reviews have been published. However, they have investigated a variety of outcomes and differ remarkably in quality. In this overview, we summarize the findings of these reviews and evaluate their quality.

Methods

The PubMed, Scopus, and Cochrane Central Register of Controlled Trials databases were comprehensively searched to identify systematic reviews and meta-analyses that compared robotic and laparoscopic surgery. We assessed the quality of the reviews using the AMSTAR-2 tool.

Results

The literature search identified 17 eligible reviews, all of which reported that the incidence of conversion to open surgery was lower for robotic surgery than for laparoscopic surgery. Most of the reviews reported no difference in the other outcomes between robotic surgery and laparoscopic surgery. However, the quality of the reviews was judged to be low or critically low.

Conclusions

Critically low quality evidence suggests that robotic surgery for rectal cancer decreases the likelihood of conversion to open surgery, but other clinical benefits remain unclear. High-quality systematic reviews in which selection of high-quality studies is combined with adequate methodology are needed to clarify the true efficacy of robotic surgery for rectal cancer.

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References

  1. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1:144–50.

    CAS  PubMed  Google Scholar 

  2. Toda S, Kuroyanagi H. Laparoscopic surgery for rectal cancer: current status and future perspective. Asian J Endosc Surg. 2014;7:2–10.

    Article  PubMed  Google Scholar 

  3. Bonjer HJ, Deijen CL, Haglind E, Group CIS. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015;373:194.

    PubMed  Google Scholar 

  4. Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15:767–74.

    Article  PubMed  Google Scholar 

  5. Baek SK, Carmichael JC, Pigazzi A. Robotic surgery: colon and rectum. Cancer J. 2013;19:140–6.

    Article  PubMed  Google Scholar 

  6. Weber PA, Merola S, Wasielewski A, Ballantyne GH. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum. 2002;45:1689–94 (discussion 1695–1686).

    Article  PubMed  Google Scholar 

  7. Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc. 2006;20:1521–5.

    Article  CAS  PubMed  Google Scholar 

  8. Wexner SD, Bergamaschi R, Lacy A, Udo J, Brolmann H, Kennedy RH, et al. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc. 2009;23:438–443.

    Article  PubMed  Google Scholar 

  9. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Higgins JPT, Green S, editors (2011) Cochrane handbook for systematic review of intervention 5. 1. 0. The cochrane collaboration.

  11. Broholm M, Pommergaard HC, Gogenur I. Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction: a systematic review and meta-analysis. Colorectal Dis. 2015;17:375–81.

    Article  CAS  PubMed  Google Scholar 

  12. Cui Y, Li C, Xu Z, Wang Y, Sun Y, Xu H, et al. Robot-assisted versus conventional laparoscopic operation in anus-preserving rectal cancer: a meta-analysis. Ther Clin Risk Manag. 2017;13:1247–57.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Huang J, Zhang Z, Wang S. Efficacy of the Da Vinci surgical system in colorectal surgery comparing with traditional laparoscopic surgery or open surgery: a meta-analysis. IJARS 2016;13:1–13.

    Google Scholar 

  14. Lee SH, Lim S, Kim JH, Lee KY. Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Ann Surg Treat Res. 2015;89:190–201.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Li X, Wang T, Yao L, Hu L, Jin P, Guo T, et al. The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer: a meta-analysis and systematic review. Med (Baltim). 2017;96:e7585.

    Article  Google Scholar 

  16. Lin S, Jiang HG, Chen ZH, Zhou SY, Liu XS, Yu JY. Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer. World J Gastroenterol. 2011;17:5214–20.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lorenzon L, Bini F, Balducci G, Ferri M, Salvi PF, Marinozzi F. Laparoscopic versus robotic-assisted colectomy and rectal resection: a systematic review and meta-analysis. Int J Colorectal Dis. 2016;31:161–73.

    Article  PubMed  Google Scholar 

  18. Memon S, Heriot AG, Murphy DG, Bressel M, Lynch AC. Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis. Ann Surg Oncol. 2012;19:2095–101.

    Article  PubMed  Google Scholar 

  19. Ohtani H, Maeda K, Nomura S, Shinto O, Mizuyama Y, Nakagawa H, et al. Meta-analysis of robot-assisted versus laparoscopic surgery for rectal cancer. In Vivo. 2018;32:611–23.

    PubMed  PubMed Central  Google Scholar 

  20. Ortiz-Oshiro E, Sanchez-Egido I, Moreno-Sierra J, Perez CF, Diaz JS, Fernandez-Represa JA. Robotic assistance may reduce conversion to open in rectal carcinoma laparoscopic surgery: systematic review and meta-analysis. Int J Med Robot. 2012;8:360–70.

    Article  PubMed  Google Scholar 

  21. Prete FP, Pezzolla A, Prete F, Testini M, Marzaioli R, Patriti A. Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2018;267:1034–46.

    Article  PubMed  Google Scholar 

  22. Sun Y, Xu H, Li Z, Han J, Song W, Wang J, et al. Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis. World J Surg Oncol. 2016;14:61.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Trastulli S, Farinella E, Cirocchi R, Cavaliere D, Avenia N, Sciannameo F, et al. Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta-analysis of short-term outcome. Colorectal Dis. 2012;14:e134–56.

    Article  CAS  PubMed  Google Scholar 

  24. Wang Y, Zhao GH, Yang H, Lin J. A pooled analysis of robotic versus laparoscopic surgery for total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutan Tech. 2016;26:259–64.

    Article  PubMed  Google Scholar 

  25. Wilder FG, Burnett A, Oliver J, Demyen MF, Chokshi RJ. A review of the long-term oncologic outcomes of robotic surgery versus laparoscopic surgery for colorectal cancer. Indian J Surg. 2016;78:214–9.

    Article  PubMed  Google Scholar 

  26. Xiong B, Ma L, Huang W, Zhao Q, Cheng Y, Liu J. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg. 2015;19:516–26.

    Article  PubMed  Google Scholar 

  27. Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H, et al. Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol. 2012;19:3727–36.

    Article  PubMed  Google Scholar 

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Correspondence to Nobuaki Hoshino.

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Hoshino, N., Sakamoto, T., Hida, K. et al. Robotic versus laparoscopic surgery for rectal cancer: an overview of systematic reviews with quality assessment of current evidence. Surg Today 49, 556–570 (2019). https://doi.org/10.1007/s00595-019-1763-y

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  • DOI: https://doi.org/10.1007/s00595-019-1763-y

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