The use of robotic or laparoscopic stapler in rectal cancer surgery: a systematic review and meta-analysis
| Autor: | K Flashman, Patricia Tejedor, Ngianga Li Kandala, Jim Khan, F. Sagias |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Colorectal cancer 030232 urology & nephrology MEDLINE Health Informatics Anastomotic Leak law.invention 03 medical and health sciences 0302 clinical medicine Postoperative Complications Surgical Staplers Randomized controlled trial Robotic Surgical Procedures law medicine Humans Pelvis business.industry Rectal Neoplasms Absolute risk reduction medicine.disease Total mesorectal excision Surgery Systematic review medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Meta-analysis Laparoscopy business |
| Zdroj: | Tejedor, P, Sagias, F, Flashman, K, Kandala, N L & Khan, J 2020, ' The use of robotic or laparoscopic stapler in rectal cancer surgery: a systematic review and meta-analysis ', Journal of Robotic Surgery . https://doi.org/10.1007/s11701-020-01126-y |
| ISSN: | 1863-2491 |
| DOI: | 10.1007/s11701-020-01126-y |
| Popis: | Minimally invasive surgery for total mesorectal excision (TME) remains technically challenging due to poor maneuverability within the pelvis, which makes extremely difficult to introduce a laparoscopic stapler (LS) for the rectal transection. We aim to perform a systematic review and meta-analysis on robotic TME after the use of robotic stapler (RS) or LS after robotic TME. A systematic literature search was performed using PubMed, MEDLINE, and Cochrane Database. Participants who underwent robotic anterior resection were considered following these criteria: (1) studies comparing RS and LS; (2) studies reporting the rate of anastomotic leakage (AL). The primary outcome was the risk of AL. Secondary outcomes included the number of firings of stapler needed. A meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement was performed. A total of 4 studies including 391 patients (LS = 251, RS = 140) were included for analysis. Regarding the number of firings, overall results suggest that the rectal stapling was achieved with less firings in the RS group, but the difference is not significant [risk difference, (95% CI) 0.42 (− 0.13, 0.97)]. There was a 56% increased odds of AL for LS compared with RS; however, this was not statistically significant (OR: 1.56; 95% CI 0.59, 4.14). With the current literature evidence, the present study could not demonstrate a clear benefit of the RS over the LS. Although the development of an AL is multifactorial and unpredictable, our data may suggest that the use of the RS could help reducing the risk of AL. There is a need of future randomized clinical trial to assess the possible benefits of the RS. |
| Databáze: | OpenAIRE |
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