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Meta-Analysis
. 2024 May 29;19(5):e0304031.
doi: 10.1371/journal.pone.0304031. eCollection 2024.

Robotic versus laparoscopic total mesorectal excision with lateral lymph node dissection for advanced rectal cancer: A systematic review and meta-analysis

Mohamed Ali Chaouch  1 , Mohammad Iqbal Hussain  2 , Adriano Carneiro da Costa  3 , Alessandro Mazzotta  4 , Bassem Krimi  5 , Amine Gouader  5 , Eddy Cotte  6 , Jim Khan  2 , Hani Oweira  7
Affiliations
Meta-Analysis

Robotic versus laparoscopic total mesorectal excision with lateral lymph node dissection for advanced rectal cancer: A systematic review and meta-analysis

Mohamed Ali Chaouch et al. PLoS One. .

Abstract

Introduction: Lateral pelvic node dissection (LPND) poses significant technical challenges. Despite the advent of robotic surgery, determining the optimal minimally invasive approach remains a topic of debate. This study aimed to compare postoperative outcomes between robotic total mesorectal excision with LPND (R-LPND) and laparoscopic total mesorectal excision with LPND (L-LPND).

Methods: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 and AMSTAR 2 (Assessing the Methodological Quality of Systematic Reviews) guidelines. Utilizing the RevMan 5.3.5 statistical package from the Cochrane Collaboration, a random-effects model was employed.

Results: Six eligible studies involving 652 patients (316 and 336 in the R-LPND and L-LPND groups, respectively) were retrieved. The robotic approach demonstrated favourable outcomes compared with the laparoscopic approach, manifesting in lower morbidity rates, reduced urinary complications, shorter hospital stays, and a higher number of harvested lateral pelvic lymph nodes. However, longer operative time was associated with the robotic approach. No significant differences were observed between the two groups regarding major complications, anastomotic leak, intra-abdominal infection, neurological complications, LPND time, overall recurrence, and local recurrence.

Conclusions: In summary, the robotic approach is a safe and feasible alternative for Total Mesorectal Excision (TME) with LPND in advanced rectal cancer. Notably, it is associated with lower morbidity, particularly a reduction in urinary complications, a shorter hospital stay and increased number of harvested lateral pelvic nodes. The trade-off for these benefits is a longer operative time.

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Conflict of interest statement

No conflict of interest to disclose

Figures

Fig 1
Fig 1. Flow-diagram of the bibliographic research.
Fig 2
Fig 2. Forest plots of the postoperative outcomes.
A: Forest plot of the postoperative morbidity. B: Forest plot of the anastomotic leak. C: Forest plot of the intra-abdomlnal abscess. D: Forest plot of the urinary complications. E: Forest plot of the neurological complications. F: Forest plot of the operative time. G: Forest plot of the hospital stay.
Fig 3
Fig 3. Forest plots of the pathological findings.
A: Forest plot of the lateral pelvic nodes dissected. B: Forest plot of the lateral pelvic nodes dissection time.
Fig 4
Fig 4. Forest plots of the oncological outcomes.
A: Forest plot of the overall recurrence. B: Forest plot of the local recurrence.
See this image and copyright information in PMC

References

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