Meta-Analysis Of The Efficacy Of Da Vinci Robot Versus Thoracoscopic Surgery In The Treatment Of NSCLC

Objective: A meta-analysis was performed to compare Da Vinci85robot-assisted thoracic surgery(RATS)with video-assisted thoracic surgery(VATS)Clinical efficacy and safety of surgical treatment of non-small cell lung cancer(NSCLC).Methods: The literatures on the clinical effect of RATS and VATS in the treatment of NSCLC were searched in Pub Med,The Cochrane Library,Web of Science,EMbase,CNKI series databases,VIP Information and Wanfang Medical network,etc.The retrieval period was from the establishment of the database to January 1,2023.Through literature screening,quality evaluation,data extraction and other steps,meta-analysis of relevant outcome indicators was performed using Rev Man 5.4 software.Results: According to the relevant search terms and search strategies,a total of 1228 literatures were retrieved from the computer database,and 35 literatures were obtained after exclusion,including 16 Chinese literatures and 19 English literatures.A total of 8171 patients were included in the study,including3892 patients who received RATS and 4279 patients who received VATS.The results of meta-analysis showed that RATS suffered less blood loss during VATS surgery than rats(MD=-41.12,95%CI=[-53.34,-28.90].P <0.00001),more lymph nodes were dissected(MD=2.48,95%CI=[1.32,3.64],P <0.0001),the conversion rate to thoracotomy was lower(MD=0.43,95%CI=[0.32,0.56],P<0.00001),and the time of chest tube insertion was shorter.(MD=-0.51,95%CI=[-0.79,-0.23],P = 0.0003 < 0.05),the incidence of postoperative complications was lower(MD=0.84,95%CI=[0.73,0.97],P = 0.02 < 0.05),and the length of hospital stay was shorter(MD=-0.90,95%CI=[-1.29,-0.51],P <0.00001),while patients with VATS had lower hospitalization costs,MD=3.01,95%CI=[2.00,4.02],(P < 0.00001).There was no significant difference in perioperative mortality(MD=0.88,95%CI=[0.38,2.04],P = 0.76 > 0.05)and operative time(MD=2.19,95%CI=[-8.98,4.60],P = 0.53).Conclusions: Compared with VATS,the number of lymph nodes removed in RATS is higher,which can effectively reduce intraoperative blood loss,reduce the probability of thoracotomy,without increasing the operation time,effectively control postoperative drainage volume,achieve early extubation,reduce postoperative complications,and shorten hospital stay,but the total hospital cost in RATS is higher.