| Objective:To systematically analyze the operative outcomes and complication of Da Vinci Robot-assisted radical hysterectomy(RRH)in the treatment of cervical cancer compared with Traditional laparoscopic radical hysterectomy(TLRH)by conducting a meta-analysis,and provide a theoretical basis for clinical decision-making.Research Methodology:A comprehensive search of PubMed,Cochrane Library,EMBASE,Web of science,CNKI,Wan fang Data and so on was performed from inception to December,2018.The related studies about comparison between RRH and TLRH for patients with cervical cancer were included in this study.The languages were limited to Chinese and English.The studies were screened and evaluated independently by more than two researchers.To extract,collect and organize the data according to the requirements of meta analysis,and then we use RevMan 5.3 for analysis.Results:This study is based on 28 literatures in the meta-analysis,including 9 Chinese studies and 19 studies in English.Application of Newcastle-Ottawa Scale(NOS scale)to evaluate the quality of the 28 studies,all meet the standard.Meta analysis show that there are 3350 cases in total,1266 cases in robot-assisted group and 2084 cases in laparoscopic surgery group.(1)The comparative result of operative outcomes in two groups were as follows: The number of pelvic lymph nodes cleared(MD = 1.85,95% CI[0.39,3.11],p = 0.01)and the amount of operative blood loss(MD =-49.34,95% CI [-73.41,-25.26],p <0.0001)and the duration of operation(MD = 21.02,95% CI(0.39,42.43),p = 0.05)were statistically significant compared with the conventional laparoscopic group.There was no statistical difference between the two groups of operative transfer rates(OR = 0.99,95% CI [0.43,2.30],p = 0.98),3-year overall survival OR = 0.98 95%CI[0.45,2.14],p = 0.96),5-year overall survival(OR = 0.88 95% CI[0.43,1.79],p = 0.72),3-year no recurrence-free survival(OR = 1.56 95% CI [0.45,5.40],p = 0.48).(2)The comparative results of postoperative complications in two groups were as follows: the incidence of postoperative bladder dysfunction after the operation of the RRH group was lower than that of the TLRH group,the difference was of statistical significance(OR = 0.47,95% CI [0.26,0.84],p = 0.01);There was no significant difference in the incidence of other complications between the two groups,including postoperative reproductive fistula,(OR=0.63,95%CI [0.34,1.19],P=0.15);viginal cuff complication,(OR=0.99,95%CI [0.42,2.35],P=0.99);lymphatic reflux disorder,(OR=1.23,95%CI [0.72,2.12],p=0.45);infection,(OR=1.16,95%CI [0.64,2.09],P=0.63);postoperative ileus,OR=1.21,95%CI [0.56-2.58],P=0.63;Intraoperative injury rate of important organs,(OR=0.63,95%CI [0.39,1.04],P=0.07).Conclusion:1.The number of pelvic lymph nodes removed by radical operation in the Da Vinci robot group was significantly higher than that in the laparoscopic operation group,but the operation time was relatively long,and there was no significant difference in the incidence of conversion to laparotomy between the two groups.2.Compared with laparoscopy group,the incidence of bladder dysfunction after operation in robot group was lower,there was no significant difference in the incidence of important organ injury,postoperative reproductive fistula,infection,intestinal obstruction,lymphatic reflux disorder and viginal cuff complication between the RRH group and the TLRH group.3.There was no significant difference in 3-year overall survival rate,5-year overall survival rate and 3-year recurrence-free survival rate between the RRH group and the TLRH group.4.On the premise of strictly mastering the indication of operation,perfecting the preoperative examination and enriching the surgical experience,RRH can be used more safely and effectively in the treatment of cervical cancer than TLRH. |
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