机器人与腹腔镜手术治疗胃癌的近期疗效对比Meta分析

目的:系统评价机器人胃切除术(RG)治疗胃癌的安全性、有效性和近期疗效。方法:检索国内外数据库,收集2005年1月—2015年1月间发表的对比RG和腹腔镜胃切除术(LG)治疗胃癌近期疗效的中文和英文文献,使用Rev Man 5.3软件进行Meta分析。结果:最终纳入15篇文献,共计5 286例胃癌患者,其中RG组1 618例,LG组3 668例。Meta分析结果显示,与LG组比较,RG组术中出血量明显减少(WMD=-38.79,95%CI=-53.73~-23.84),淋巴结清扫数目多(WMD=2.13,95%CI=1.45~2.80),胃肠功能恢复时间、进食时间和术后住院时间缩短(WMD=-0.27,95%CI=-0.37~-0.16;WMD=-0.25,95%CI=-0.37~-0.14;WMD=-0.82,95%CI=-1.32~-0.32),但手术时间明显延长(WMD=37.39,95%CI=26.79~47.98)(均P<0.05)。两组近端切缘距离、远端切缘距离和术后并发症发生率方面的差异无统计学意义(WMD=0.05,95%CI=-0.11~0.20;WMD=0.30,95%CI=-0.28~0.88;OR=0.97,95%CI=0.79~1.19)(均P>0.05)。结论:RG治疗胃癌安全可行,可取得与LG相当或更佳的近期疗效和肿瘤根治效果。

Robotic versus laparoscopic gastrectomy for gastric cancer: a Meta-analysis of short-term results

Objective: To systematically evaluate the safety, efficacy and short-term results of robotic gastrectomy (RG) for gastric cancer. Methods: The literature in both Chinese and English regarding studies comparing RG and laparoscopic gastrectomy (LG) published between January 2005 and January 2015 were searched from national and international databases. Meta-analysis was performed by using RevMan 5.3 software. Results: Fifteen studies were finally included involving 5 286 patients, of whom 1 618 cases underwent RG (RG group) and 3 668 cases underwent LG (LG group). Results of Meta-analysis indicated that in RG group compared with LG group, the intraoperative blood loss was significantly reduced (WMD=–38.79, 95% CI=–53.73––23.84), number of dissected lymph nodes was increased (WMD=2.13, 95% CI=1.45–2.80), time to first flatus and oral intake, and length of hospital stay were shortened (WMD=–0.27, 95% CI=-0.37––0.16; WMD=–0.25, 95% CI=–0.37––0.14; WMD=–0.82, 95% CI=–1.32––0.32), but the operative time was significantly prolonged (WMD=37.39, 95% CI=26.79–47.98) (all P<0.05). There was no significant difference in the length of proximal and distal resection margin, or incidence of postoperative complications between the two groups (WMD=0.05, 95% CI=–0.11–0.20; WMD=0.30, 95% CI=–0.28–0.88; OR=0.97, 95% CI=0.79–1.19) (all P>0.05). Conclusion: RG is safe and feasible in treatment of gastric cancer, and can achieve comparable or better short-term and radical effect than LG.