Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies

K. Phan, H. R. Kahlaee, Seon Hahn Kim, J. W.T. Toh

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: The usage of robotic surgery in rectal cancer is increasing, but there is an ongoing debate as to whether it provides any benefit. The aim of the present study was to determine if robotic surgery results in less conversion to an open operation than laparoscopic rectal cancer surgery. Methods: A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club and Database of Abstracts of Review of Effectiveness. Included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies comparing a robotic vs. laparoscopic approach to rectal cancer surgery. The primary endpoint was conversion to open. All statistical analyses and data synthesis were conducted using STATA/IC version 14·2, Windows 64 bit (StataCorp LP, College Station, TX, USA) Results: Six hundred and twenty-one studies were identified through electronic database search. After application of selection criteria as per PRISMA and MOOSE criteria, six RCTs and five PSM articles were analyzed. From the six RCTs, 512 robotic and 519 laparoscopic cases were evaluated. There was a significantly lower rate of conversion for the robotic surgery arm (4.1% vs. 8.1%, OR 0.28; 95% CI 0.00–0.57). Of the five PSM studies, 2097 robotic and 3053 laparoscopic cases were evaluated. There was a significantly lower conversion to open rate found in the robotic surgery cohort (7.4% vs. 15.6%; OR 0.39; 95% CI 0.30–0.47). Pooled RCT and PSM data demonstrated significantly lower conversion rates for robotic surgery (6.7% vs. 14.5%; OR 0.38; 95% CI 0.30–0.46). Conclusions: Robotic surgery for rectal cancer is associated with reduced conversion to open surgery compared to a laparoscopic approach.

Original languageEnglish
JournalTechniques in Coloproctology
DOIs
Publication statusAccepted/In press - 2019 Jan 1

Fingerprint

Propensity Score
Robotics
Rectal Neoplasms
Meta-Analysis
Randomized Controlled Trials
Databases
Conversion to Open Surgery
Statistical Data Interpretation
PubMed
Patient Selection
Guidelines

Keywords

  • Conversion to open surgery
  • Laparoscopic surgery
  • Meta-analysis
  • Rectal cancer
  • RECTUM/surg
  • Robotic surgical procedures

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

@article{2310a2c7e4ee4448afe4e8ffbeffe14a,
title = "Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies",
abstract = "Background: The usage of robotic surgery in rectal cancer is increasing, but there is an ongoing debate as to whether it provides any benefit. The aim of the present study was to determine if robotic surgery results in less conversion to an open operation than laparoscopic rectal cancer surgery. Methods: A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club and Database of Abstracts of Review of Effectiveness. Included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies comparing a robotic vs. laparoscopic approach to rectal cancer surgery. The primary endpoint was conversion to open. All statistical analyses and data synthesis were conducted using STATA/IC version 14·2, Windows 64 bit (StataCorp LP, College Station, TX, USA) Results: Six hundred and twenty-one studies were identified through electronic database search. After application of selection criteria as per PRISMA and MOOSE criteria, six RCTs and five PSM articles were analyzed. From the six RCTs, 512 robotic and 519 laparoscopic cases were evaluated. There was a significantly lower rate of conversion for the robotic surgery arm (4.1{\%} vs. 8.1{\%}, OR 0.28; 95{\%} CI 0.00–0.57). Of the five PSM studies, 2097 robotic and 3053 laparoscopic cases were evaluated. There was a significantly lower conversion to open rate found in the robotic surgery cohort (7.4{\%} vs. 15.6{\%}; OR 0.39; 95{\%} CI 0.30–0.47). Pooled RCT and PSM data demonstrated significantly lower conversion rates for robotic surgery (6.7{\%} vs. 14.5{\%}; OR 0.38; 95{\%} CI 0.30–0.46). Conclusions: Robotic surgery for rectal cancer is associated with reduced conversion to open surgery compared to a laparoscopic approach.",
keywords = "Conversion to open surgery, Laparoscopic surgery, Meta-analysis, Rectal cancer, RECTUM/surg, Robotic surgical procedures",
author = "K. Phan and Kahlaee, {H. R.} and Kim, {Seon Hahn} and Toh, {J. W.T.}",
year = "2019",
month = "1",
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doi = "10.1007/s10151-018-1920-0",
language = "English",
journal = "Techniques in Coloproctology",
issn = "1123-6337",
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TY - JOUR

T1 - Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates

T2 - a meta-analysis of randomized controlled trials and propensity-score-matched studies

AU - Phan, K.

AU - Kahlaee, H. R.

AU - Kim, Seon Hahn

AU - Toh, J. W.T.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The usage of robotic surgery in rectal cancer is increasing, but there is an ongoing debate as to whether it provides any benefit. The aim of the present study was to determine if robotic surgery results in less conversion to an open operation than laparoscopic rectal cancer surgery. Methods: A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club and Database of Abstracts of Review of Effectiveness. Included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies comparing a robotic vs. laparoscopic approach to rectal cancer surgery. The primary endpoint was conversion to open. All statistical analyses and data synthesis were conducted using STATA/IC version 14·2, Windows 64 bit (StataCorp LP, College Station, TX, USA) Results: Six hundred and twenty-one studies were identified through electronic database search. After application of selection criteria as per PRISMA and MOOSE criteria, six RCTs and five PSM articles were analyzed. From the six RCTs, 512 robotic and 519 laparoscopic cases were evaluated. There was a significantly lower rate of conversion for the robotic surgery arm (4.1% vs. 8.1%, OR 0.28; 95% CI 0.00–0.57). Of the five PSM studies, 2097 robotic and 3053 laparoscopic cases were evaluated. There was a significantly lower conversion to open rate found in the robotic surgery cohort (7.4% vs. 15.6%; OR 0.39; 95% CI 0.30–0.47). Pooled RCT and PSM data demonstrated significantly lower conversion rates for robotic surgery (6.7% vs. 14.5%; OR 0.38; 95% CI 0.30–0.46). Conclusions: Robotic surgery for rectal cancer is associated with reduced conversion to open surgery compared to a laparoscopic approach.

AB - Background: The usage of robotic surgery in rectal cancer is increasing, but there is an ongoing debate as to whether it provides any benefit. The aim of the present study was to determine if robotic surgery results in less conversion to an open operation than laparoscopic rectal cancer surgery. Methods: A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club and Database of Abstracts of Review of Effectiveness. Included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies comparing a robotic vs. laparoscopic approach to rectal cancer surgery. The primary endpoint was conversion to open. All statistical analyses and data synthesis were conducted using STATA/IC version 14·2, Windows 64 bit (StataCorp LP, College Station, TX, USA) Results: Six hundred and twenty-one studies were identified through electronic database search. After application of selection criteria as per PRISMA and MOOSE criteria, six RCTs and five PSM articles were analyzed. From the six RCTs, 512 robotic and 519 laparoscopic cases were evaluated. There was a significantly lower rate of conversion for the robotic surgery arm (4.1% vs. 8.1%, OR 0.28; 95% CI 0.00–0.57). Of the five PSM studies, 2097 robotic and 3053 laparoscopic cases were evaluated. There was a significantly lower conversion to open rate found in the robotic surgery cohort (7.4% vs. 15.6%; OR 0.39; 95% CI 0.30–0.47). Pooled RCT and PSM data demonstrated significantly lower conversion rates for robotic surgery (6.7% vs. 14.5%; OR 0.38; 95% CI 0.30–0.46). Conclusions: Robotic surgery for rectal cancer is associated with reduced conversion to open surgery compared to a laparoscopic approach.

KW - Conversion to open surgery

KW - Laparoscopic surgery

KW - Meta-analysis

KW - Rectal cancer

KW - RECTUM/surg

KW - Robotic surgical procedures

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