Application of robotic surgery and traditional laparoscopic surgery in lymph node dissection for gynecological cancer: A meta‑analysis

Abstract

Since the advantages of robotic surgery and laparoscopic surgery in the number of lymph node resections are not well understood, this meta-analysis used evidence-based medicine to assess the difference in the number of lymph nodes retrieved in gynecological cancer between the two surgical methods to guide clinical treatment. In the present meta-analysis, the Pubmed, Embase, Cochrane, China National Knowledge Infrastructure and Wanfang libraries were searched for articles that were published from the time of the database's inception to January 2021, including cohort studies and randomized controlled trials, where the observation group underwent robotic surgery to treat gynecological cancers and the control group underwent laparoscopic surgery to treat gynecological cancers, including cervical and ovarian cancers and endometrial cancers. Duplicate publications, studies with no full text, incomplete information or where the authors were unable to perform data extraction, animal experiments, reviews and systematic reviews were excluded. STATA 15.1 was used to analyze the data. Robotic surgery resulted in a significant increase in the number of lymph nodes retrieved from the pelvis [standard mean difference (SMD)=0.24; 95% CI, 0.04-0.45; P=0.007] and para-aortic (SMD=0.41; 95% CI, 0.13-0.69; P=0.004) regions compared with the number retrieved by laparoscopic surgery. Furthermore, there was no significant difference in operating time between robotic and laparoscopic surgery, despite the use of different instruments (SMD=0.12; 95% CI, -0.35-0.58; P=0.616). The amount of blood lost during robotic surgery was significantly less compared with that lost during laparoscopic surgery [SMD=-0.40; 95% CI, -0.58-(-0.22); P<0.001]. The present study evaluated cancer recurrence and death in further detail, and no statistically significant difference was demonstrated between robotic surgery and laparoscopic surgery in terms of recurrence rate [odds ratio (OR)=0.59; 95% CI, 0.21-1.65; P=0.318] and mortality rate (OR=0.31; 95% CI, 0.08-1.30; P=0.109). The present study demonstrated that robotic surgery was able to retrieve more pelvic and para-aortic lymph nodes than traditional laparoscopic surgery, which was consistent with previous reports. With regards to blood loss, The difference in operation time between the two surgical methods was not statistically significant, whereas the estimated blood loss of robotic surgery was significantly lower than that of traditional laparoscopic surgery. There was no statistically significant difference in the recurrence rate and mortality rate of the two surgical modality.

Keywords: gynecological cancer; laparoscopic surgery; lymph node dissection; robotic surgery.

Figure 1.

Flow diagram for selection of studies. CNKI, China National Knowledge Infrastructure.

Figure 2.

The quality assessment of randomized controlled studies. Green circles indicated low risk and yellow circles indicated undescribed.

Figure 3.

Comparison in the number of (A) pelvic and (B) para-aortic lymph nodes retrieved by robotic surgery and laparoscopic surgery; comparison in (C) operation time and (D) estimated blood loss between robotic surgery and laparoscopic surgery; comparison in (E) recurrence rate and (F) mortality rate between robotic surgery and laparoscopic surgery. SMD, standard mean difference.

Figure 4.

Subgroup analysis of comparison in the number of (A) pelvic and (B) para-aortic lymph nodes retrieved by robotic surgery and laparoscopic surgery; comparison of (C) operation time and (D) estimated blood loss between robotic surgery and laparoscopic surgery. SMD, standard mean difference; D + L, random effects model; I–V, fixed effects model.

Figure 5.

Publication bias of the analysis of the number of (A) pelvic and (B) para-aortic lymph nodes retrieved by robotic surgery and laparoscopic surgery; comparison of (C) operation time and (D) estimated blood loss between robotic surgery and laparoscopic surgery. SMD, standard mean difference; se, standard error.