Meta-analysis Of Short-term Efficacy Of Robotic Surgery And Laparoscopic Surgery In Total Mesorectal Resection Of Middle And Low Rectal Cancer

Objectives:To explore the short-term efficacy of total mesorectal resection of middle and low rectal cancer using robot compared with laparoscopy.Methods:A meta-analysis was performed on Chinese and English literature comparing the recent efficacy of robotic total mesorectal excision(RTME)and laparoscopic total mesorectal excision(LTME)between January 2010 and December 2020.The tumor site was defined as the middle and low rectum(≤10cm from the anal margin).The basic information of each piece of literature was recorded in detail,including the publication year of the literature,the name of the first author,study type,literature quality,risk of bias,number of cases included in the study,age,BMI,the proportion of male patients,and whether patients received preoperative radiotherapy or chemotherapy.Indicators of research include the incidence of complications(including general complications,intestinal obstruction,pulmonary infection,urinary retention,infection of the incision,incidence of anastomotic fistula),transit operation rate,number of intraoperative lymph node cleaning,the positive rate of circumferential resection margin,mesorectum complete resection rate for the first time,intraoperative blood loss,postoperative anal exhaust time defecate,operation time,length of hospital stay,etc.Meta-analysis was conducted for all indicators included in the study,and the combined effect size(P<0.05)was considered statistically significant.Finally,publication bias detection and sensitivity analysis were conducted to determine whether the results were credible.Results:According to the retrieval strategy,a total of 444 pieces of literature were retrieved,and 36 duplicates were excluded.According to the inclusion and exclusion criteria,398 literatures were excluded.Finally,10 pieces of literature were included in the study,of which two were RCT studies and eight were retrospective analyses.A total of 992 patients with RTME and 1600 patients with LTME were enrolled.There were no significant differences in the overall incidence of complications(OR=0.92,95%CI:0.75-1.13,P=0.15),in the incidence of intestinal obstruction(OR=0.73,95%CI:0.46-1.16,P=0.19),in the incidence of pulmonary infection(OR=0.71,95%CI:0.24-2.12,P=0.54),and in the incidence of urinary retention(OR=1.22,95%CI:0.53-2.80,P=0.64)The incidence of incision infection in RTME group was lower than that in LTME group(OR=0.61,95%CI:0.39～0.93,P=0.02),the incidence of the anastomotic fistula was not statistically significant(OR=1.10,95%CI:0.77-1.58,P=0.59),the rate of transfer to laparotomy was not statistically significant(OR=0.66,95%CI:0.33～1.32,P=0.24),and the number of lymph node dissection in RTME group was higher than that in LTME group(MD=1.87,95%CI:0.49～3.25,P=0.008).There was no statistically significant difference in the positive rate of circumferential resection margin(OR=0.82,95%CI:0.50-1.35,P=0.42),no statistically significant difference in TME quality(OR=0.70,95%CI:0.28-1.77,P=0.45),and no statistically significant difference in intraoperative blood loss(MD=-2.26,95%CI:-44.44～39.91,P=0.92),the first anal exhaust time in the RTME group was earlier than that in the LTME group,the difference was statistically significant(MD=-0.13,95%CI:-0.22～-0.04,P=0.003),the operation time in the RTME group was significantly longer(MD=62.31,95%CI:32.30～92.32,P<0.0001),and the hospitalization time in the RTME group was shorter(MD=-1.30,95%CI:-2.54～-0.06,P<0.0001).There was no publication bias between studies,and sensitivity analysis showed that conclusion about the hospitalization time was unreliable.Conclusions:In low and middle rectal cancers,the advantage of RTME is manifested in earlier first anal exhaust and lower incidence of incisional infection.However,RTME operation time is longer.Meta-analysis results of other indicators,including intraoperative lymph node dissection,intraoperative blood loss,TME quality,and overall complication rate,showed no significant advantage of RTME.For the short-term efficacy of total mesorectal resection for middle and low rectal cancer,whether RTME is superior to LTME still needs the results of a large number of randomized controlled trials to prove.