Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies
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.
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)
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).
Robotic surgery for rectal cancer is associated with reduced conversion to open surgery compared to a laparoscopic approach.
KeywordsRobotic surgical procedures Laparoscopic surgery RECTUM/surg Rectal cancer Conversion to open surgery Meta-analysis
Dr James W. T. Toh received the Morgan Fellowship from the Royal Australasian College of Surgeons to conduct his international robotic fellowship in Korea.
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.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The authors have complied with appropriate ethical standards in preparation and publication of this manuscript.
For this type of study, formal consent is not required.
- 7.Ortiz-Oshiro E, Sanchez-Egido I, Moreno-Sierra J, Perez CF, Diaz JS, Fernandez-Represa JA (2012) Robotic assistance may reduce conversion to open in rectal carcinoma laparoscopic surgery: systematic review and meta-analysis. Int J Med Robot Comput Assist Surg MRCAS 8(3):360–370CrossRefGoogle Scholar
- 18.Phan K, Tian DH, Cao C, Black D, Yan TD (2015) Systematic review and meta-analysis: techniques and a guide for the academic surgeon. Ann Cardiothorac Surg 4(2):112–122Google Scholar
- 23.Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Biancafarina A, Casciola L (2009) Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS J Soc Laparoendosc Surg 13(2):176–183Google Scholar
- 25.Kim MJ, Park SC, Park JW et al (2017) Robot-assisted versus laparoscopic surgery for rectal cancer. Ann Surg 2017:1Google Scholar
- 26.Ackerman SJ, Daniel S, Baik R et al (2017) Comparison of complication and conversion rates between robotic-assisted and laparoscopic rectal resection for rectal cancer: which patients and providers could benefit most from robotic-assisted surgery? J Med Econ 2017:1–8Google Scholar
- 30.Kim J, Baek SJ, Kang DW et al (2017) Robotic resection is a good prognostic factor in rectal cancer compared with laparoscopic resection: long-term survival analysis using propensity score matching. Dis Colon Rectum 60(3):266–273Google Scholar