Comparison of robot-assisted surgery, laparoscopic-assisted surgery, and open surgery for the treatment of colorectal cancer: A network meta-analysis

Abstract

Background: The aim of this study was to find the better treatment for colorectal cancer (CRC) by comparing robot-assisted colorectal surgery (RACS), laparoscopic-assisted colorectal surgery (LACS), and open surgery using network meta-analysis.

Methods: A literature search updated to August 15, 2017 was performed. All the included literatures were evaluated according to the quality evaluation criteria of bias risk recommended by the Cochrane Collaboration. All data were comprehensively analyzed by ADDIS. Odds ratio (OR), mean difference (MD), and 95% confidence interval (CI) were used to show the effect index of all data. The degree of convergence of the model was evaluated by the Brooks-Gelman-Rubin method with the potential scale reduction factor (PSRF) as the evaluation indicator.

Results: The PSRF values of operation time, estimated blood loss, length of hospital stay, complication, mortality, and anastomotic leakage ranged from 1.00 to 1.01, and those of wound infection, bleeding, and ileus ranged from 1.00 to 1.02. Open surgery had the shortest operation time compared with LACS and RACS. Furthermore, compared with LACS, the amount of blood loss, complication, mortality, bleeding rate, and ileus rate for RACS were the least, and the length of hospital stay for RACS was the shortest. The anastomotic leakage rate for LACS was the least, but there was no significant difference compared with those of RACS and open surgery. The wound infection rate for LACS was the least, but there was no significant difference compared with that of RACS.

Conclusion: RACS might be a better treatment for patients with CRC.

Figure 1

Literature search and study selection.

Figure 2

Quality assessments of the included studies. (A) Bias risk of the included studies. (B) Sensitivity and specificity of the included studies. “+,” low risk of bias; “−,” high risk of bias, and “?,” unclear risk of bias.

Figure 2 (Continued)

Quality assessments of the included studies. (A) Bias risk of the included studies. (B) Sensitivity and specificity of the included studies. “+,” low risk of bias; “−,” high risk of bias, and “?,” unclear risk of bias.

Figure 3

(A) Results of rank probability for operation time. (B) Results of rank probability for estimated blood loss. (C) Results of rank probability for length of hospital stay. (D) Results of rank probability for complication. (E) Results of rank probability for mortality. (F) Results of rank probability for anastomotic leakage. (G) Results of rank probability for wound infection. (H) Results of rank probability for bleeding. I. Results of rank probability for ileus. LACS = laparoscopic-assisted colorectal surgery, RACS = robot-assisted colorectal surgery.

Figure 3 (Continued)

(A) Results of rank probability for operation time. (B) Results of rank probability for estimated blood loss. (C) Results of rank probability for length of hospital stay. (D) Results of rank probability for complication. (E) Results of rank probability for mortality. (F) Results of rank probability for anastomotic leakage. (G) Results of rank probability for wound infection. (H) Results of rank probability for bleeding. I. Results of rank probability for ileus. LACS = laparoscopic-assisted colorectal surgery, RACS = robot-assisted colorectal surgery.