| Background: Since the introduction of minimally invasive techniques,surgical methods have changed dramatically.New surgical methods can minimize surgical trauma,reduce postoperative pain and improve patients’ quality of life.Since the first laparoscopic surgery for gastric cancer was reported,laparoscopic radical gastrectomy has been in development for nearly 40 years.Compared with traditional open surgery,laparoscopic technique can effectively reduce surgical trauma,postoperative complications,mortality and length of stay,reduce the cost of hospitalization,and improve patients’ quality of life and life cycle after surgery.In recent years,with the popularity of Da Vinci surgical operating system and the growth of robot-assisted surgery,the safety and effectiveness of Da Vinci robot-assisted surgery have been reported and compared with laparoscopic surgery.However,the results were not satisfying,Da Vinci robot-assisted surgery is far more expensive and timeconsuming than laparoscopic surgery,and it has no obvious advantages in postoperative complications and length of stay compared with laparoscopy.So people are worried about the new technology of Da Vinci robot-assisted surgery.In the case of higher cost and longer operation time,whether robot-assisted surgery has advantages over fatality rate,recurrence rate and long-term efficacy of a specific disease.According to statistics of certain researches,nearly half a million people die of stomach cancer every year in China,and there were 679,000 new cases,nearly 90 percent of which were advanced gastric cancer.Most patients may have lymph node involvement.Therefore,in radical gastrectomy,the removal of lymph nodes around the stomach is particularly important.It has been reported that the number of lymph nodes dissected during surgery is closely related to the recurrence and metastasis of gastric cancer after surgery.In the radical operation of distal gastric cancer,the lymph node dissection around the perigastric pancreatic body is the most important part of the whole operation.Objective: Meta-analysis evaluation method through the system,comparing Da Vinci robot-assisted laparoscopic distal gastrectomy with distal gastric cancer recent treatment cure,clarified on the distal gastrectomy efficacy and safety of Leonardo Da Vinci robot.Methods: Searching PubMed,Embase,Cochrane Library,Web of Science by taking“gastric cancer,gastrectomy,robotic,laparoscopic”as keywords to collect the literatures,Searching Chinese Journal Full-text Database,Wanfang Data,VIP database and Chinese biomedical journal literature databases by taking “ distal gastric,pyloric cancer,Da Vinci robotic,laparoscopic” as keywords to collect the literatures about comparative analysis of distal gastrectomy assisted by the Da Vinci robot and laparoscopic distal gastrectomy.By the operation time,and the number of detection of lymph node surgery blood loss evaluate the effectiveness of three continuous variables Da Vinci robot-assisted surgery,the incidence of postoperative complications,mortality two dichotomous evaluation Da Vinci robot-assisted surgery the safety of operation,the rest of the secondary outcomes for the first time after eating time and postoperative hospital stay.To collect outcome measures Meta-analysis RevMan5.3 software.Retrieval time is from January 2015 to December 2019.Results: 15 documents conforming to the standard were included.There were 2692 patients,of which 1148 were in the robot group and 1544 were in the laparoscope group.Meta analysis showed that,compared with the group laparoscopy,the distal end of the robot group underwent gastrectomy patient’s operative time increase(WMD = 25.31,95% CI =12.33 ~ 38.28,P = 0.001),to reduce blood loss(WMD =-35.96,95% CI =-45.98 ~-25.95,P<0.05),increased number of detected nodes(WMD = 4.00,95% CI = 2.41 ~ 5.59,P <0.05),no significant incidence of postoperative complications difference(OR = 0.80,95% CI = 0.63~ 1.03,P> 0.05),no significant differences in mortality(OR = 0.71,95% CI = 0.36 ~ 1.38,P> 0.05),secondary outcomes,the distal end of the robot group postoperative first feeding time is shortened(WMD =-0.22,95% CI =-0.32 ~-0.11,P <0.05),no significant difference in postoperative hospital stay(WMD =-0.60,95% CI =-1.2 ~ 0.13,P> 0.05).Conclusion: From the effectiveness point of view,the Da Vinci robot assisted distal gastrectomy can significantly reduce the amount of blood loss during surgery,increasing the number of lymph node detection,reduce postoperative eating time,more effective than laparoscopic surgery;in terms of safety,the Da Vinci robot-assisted surgery in postoperative hospital stay,laparoscopic surgery and no complication rate and mortality are obviously differences,achieve a similar short-term treatment therapeutic effect. |
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