A Meta-Analysis Of The Clinical Effects Of Da Vinci Robot-Assisted And Laparoscopic Hepatectomy In The Treatment Of Liver Tumors

Backgroud:At the end of the twentieth century,minimally invasive surgical techniques have been increasingly used to treat liver tumors.Since the first case of laparoscopic liver resection(LLR)was reported in 1991,LLR has developed rapidly,and then LLR global conferences were held in 2008 and 2014,respectively.LLR was considered to be a safe and effective method for surgical treatment of liver tumors.However,due to the complexity of liver physiology and anatomy,the difficulty of intraoperative exposure,the high risk of intraoperative bleeding and the narrow operation space,the shortcomings of traditional laparoscopic hepatectomy have also been exposed.After entering the 21 st century,as a new technology,Da Vinci robotic surgery system has been gradually applied in clinical practice,which overcomes some of the technical defects of traditional laparoscopic surgery,but also has some shortcomings.The clinical efficacy of robotic-assisted liver resection(RALR)and laparoscopic hepatectomy(LLR)in the treatment of liver tumors remains controversial in clinical practice.Objective:To evaluate the clinical effect of RALR and LLR in the treatment of liver tumors,and to provide reference for clinical practice.Methods:From 2000 to October 2018,the computer retrieved all the literatures published on RALR and LLR for the treatment of liver tumors from domestic and foreign databases.The clinical effects of RALR and LLR for liver tumors were analyzed by using RevMan 5.3 software.Results:Fourteen eligible literatures were included,involving 1021 patients,434 in RALR group and 587 in traditional LLR group.Meta-analysis of the included literature shows that: the operation time(MD=5.44,95%CI=42.90~91.16,P<0.00001)of RLR group and the hospitalization time(MD=2.57,95%CI :0.05 ~ 0.37,P=0.01)was significantly longer than that in the LLR group,and the intraoperative bleeding volume in RALR group was higher than that in LLR group(MD=3.08,95%CI=24.21~ 108.67,P=0.002).however the incidence of total postoperative complications(OR=2.26,95%CI:0.48~0.95,P=0.02),bleeding(OR=2.25,95%CI:0.21~0.90,P=0.02)and maximum diameter of tumors(MD=3.81,95%CI=0.31~0.95,P=0.0001)were significantly favors than LLR group.There were no significant differences in the conversion rate to laparotomy(OR=0.73,95%CI:0.51~1.36,P=0.37),the incidence of postoperative infection(MD=0.16,95%CI=0.45~1.6,P=0.88),the incidence of postoperative biliary fistula(OR=0.84,95%CI:0.33~1.56,P=0.40),the R0 resection rate(OR=1.21,95%CI:0.40~1.24,P=0.23)between the two groups.Conclusion:Compared with traditional LLR,RALR has broad prospects and is safe and effective.Conditional licensing can replace traditional LLR.In the treatment of liver tumors,the former reduces the incidence of total postoperative complications and bleeding,is conducive to resection of larger diameter tumors,and expands the indications of laparoscopic hepatectomy for liver tumors.