Meta Analysis Of Efficacy And Safety Of Davinci Robot Versus Traditional Laparoscopy And Laparotomy In The Treatment Of Cervical Cancer

Objective:To compare the efficacy and safety of Davinci robotic assisted laparoscopy(RRH)with conventional laparoscopic(LRH)and open surgery(ORH)in the treatment of cervical cancer.Methods:By searching Pubmed,Embase,Web of science,Medline,China Knowledge Network(CNKI),China Bio-Documentation Database(CBM),Wanfang database,VIP database,time limit set from January 2014 to January 2019,the language was set up in both Chinese and English.Manually searching the relevant category magazines.Using Maxites and Baidu Scholars to minimize the omissions,and to screen out randomized controlled trials,retrospective case-control studies,prospective cohort studies about this study.According to the established inclusion and exclusion criteria,the qualified documents were selected,and finally the extracted data was analyzed by RenMan5.3 software.Results:This study included 31 related literatures,9 in Chinese,22 in English,including5 prospective studies,26 retrospective case-control studies,and a total sample size of9220 patients.Sixteen articles reported the related data of RRH and LRH,eight articles reported the related data of RRH and ORH,seven articles reported the related data about three surgical procedures.The results of the study showed that compared with LRH,there was no significant differences about recurrence rate [OR=0.64,95 %CI(0.41,1.01),P=0.06],the mortality [OR=0.54,95%CI(0.28,1.04),P=0.06],RRH had longer operation time(OT)[SMD=0.58,95%CI(0.12,1.04),P=0.01],but the RRH had less BL [SMD=-0.71,95%CI(-1.13,-0.28),P=0.001],more lymph node dissection [SMD=0.2,95%CI(0.02,0.39),P=0.03],shorter LOS[SMD=-0.36,95%CI(-0.54,-0.18),P<0.0001],lower intraoperative complications[OR=0.47,95%CI(0.32,0.68),P< 0.00001] and postoperative complications[OR=0.57,95%CI(0.41,0.79),P=0.0008];Compared with ORH,about OT[SMD=-0.08,95%CI(-0.63,0.47),P=0.77],the number of lymph node[SMD=-0.13,95%CI(-0.44,0.18),P=0.41],recurrence rate[OR=0.84,95%CI(0.57,1.25),P=0.40],mortality[OR=0.98,95%CI(0.56,1.71),P=0.95],there was no significant difference among RRH and ORH,but the RRH had significant less BL[SMD=-1.38,95%CI(-1.73,-1.03),P<0.00001],and shorter LOS[SMD=-1.01,95% CI(-1.42,-0.59),P<0.00001],lower intraoperative complications[OR=0.43,95%CI(0.31,0.60),P<0.00001]and postoperative complications[OR= 0.35,95%CI(0.25,0.50,P<0.00001].Conclusion:This study showed that there was no significant difference about recurrence rate and mortality among RRH and LRH,although the operation time of RRH was slightly longer,but the RRH had less bleeding,more lymph node resection,and shorter postoperative hospital stay,lower intraoperative complications and lower postoper-ative complications than LRH.Compared with ORH,there was no significant difference about operation time,number of lymph node resection,recurrence rate,and mortality between the two surgical procedures.However,RRH had less bleeding,shorter postoperative hospital stay,lower intraoperative complications and lower postoperative complications than ORH.The Da Vinci robotic surgery system is a safe and effective minimally invasive procedure,but its long-term efficacy still needs more large-scale clinical randomized controlled trials to confirm.