Comparison Of Clinical Efficacy And Safety Between Da Vinci Robotic Intersphincteric Resection And Laparoscopic Intersphincteric Resection For Low Rectal Cancer:a Meta-analysis

Background:The intersphincteric resection(ISR)can help clinicians develop treatment options that are more beneficial to save patient’ anus to a large extent and restore original bowel continuity.Robot-assisted rectum resection is increasingly used worldwide,but comparisons of perioperative,functional,and oncologic outcomes between robotic intersphincteric resection and laparoscopic intersphincteric resection remain inconsistent.Up to now,there is few relevant investigations to compare the clinical efficacy and safety of robotic and laparoscopic intersphincteric resection.Objective:The purpose of this article is to compare the feasibility and safety for low rectal cancer in oncological outcomes,intraoperative and postoperative clinical efficacy and safety between laparoscopic intersphincteric resection(L-ISR)and robotic intersphincteric resection(R-ISR).Methods:A comprehensive search of online databases was performed on Pub Med,EMBASE,the Cochrane Library,Web of Science,to obtain comparative studies of R-ISR and L-ISR.The last search was done on July 31 2020.We choose the articles we need according to the predetermined eligibility criteria of the articles.Relevant articles were screened by two independent researchers,and divergences were handled to reach an agreement,and then the information was recorded.We read the articles carefully and extracted data in all included studies.The statistical analysis was performed by Review Manager version 5.4.Result:Five studies were included for this meta-analysis.In total,510 patients(273patients underwent R-ISR and 237 patients underwent L-ISR)were included.Here are the results: 1.The number of lymph node harvest was significantly smaller in the R-ISR group than the L-ISR group(MD=-1.71,95%CI[-3.21,-0.21],p=0.03).The circumferential resection margin was not significantly different between the two surgery groups of R-ISR and L-ISR(OR=0.61,95%CI[0.27,1.37],p=0.23).The distal resection margin was no significantly different in two groups(MD=0.01,95%CI[-0.16,0.18],p=0.88).2.The operative time of the R-ISR group was statistically longer than the L-ISR group,however the R-ISR group had statistically lower conversion rate(OR=0.20,95%CI[0.04,0.95],p=0.04).R-ISR group compared to L-ISR had statistically lower estimated intraoperative blood loss(MD=-19.98,95%CI[-33.14,-6.81],p=0.003).3.As for the postoperative efficacy,the length of hospital stay of the R-ISR group is statistically shorter than the L-ISR group(MD=-1.53,95%CI[-2.10,-0.96],p<0.0001).Postoperative urinary complications of the R-ISR group were statistically lower than the L-ISR group(OR=0.31,95%CI[0.14,0.71],p=0.006).No significant difference was discovered in time to postoperative diet(MD=-0.20,95%CI[-0.67,0.27],p=0.41),time to first flatus(MD=-0.21,95%CI[-0.75,0.33],p=0.44),overall complications(OR=0.76,95%CI[0.50,1.14],p=0.18),anastomotic leakage(OR=0.85,95%CI[0.38,1.90],p=0.69),postoperative ileus(OR=0.87,95%CI[0.37,2.05],p=0.75),intra-abdominal abscess(OR=0.64,95%CI[0.18,2.31],p=0.49)between the two groups.Conclusion:As a treatment of low rectal tumors,R-ISR,which is defined as a safe and effective alternative treatment option to L-ISR,has broad prospection.The advantage outcomes of R-ISR include lower estimated intraoperative blood loss,conversion rate,postoperative urinary complications,and hospitalization days as compared to LISR.Further prospective randomized studies are required to assess the long-term oncological and functional outcomes of R-ISR for low rectal cancer.