The Safety And Effectiveness Of Robotic Versus Laparoscopic Hepatectomy For Hepatic Neoplasms : A Meta-analysis

Objective:Robotic-assisted liver resection(RALR) was introduced as procedures of overcoming the limitations of traditional laparoscopic liver resection(LLR). However,RALR is not perfect, it has its own limitations. Which approach has better safety and efficacy, there are still some controversy.The aim of this review was to To perform a systematic review and meta-analysison robotic-assisted vs laparoscopic liver resections from all published studies and the results of comparative studies of RALR versus LLR for hepatic neoplasm.Methods:Eligible studies involved RALR that published between January 2000 and Novembre2015 were reviewed systematically. Two reviewers independently extracted data of the manuscripts, and assessed quality of included studies using Newcastle-Ottawa Scale.Rev Man5.3 software was used to do statistical analysis. Comparisons between RALS and LLR were pooled and analyzed by meta-analytical techniques using random- or fixed-effects models, as appropriate.The primary outcome measures were set for estimated blood loss, operative time,conversion rate, R1 resection rate, postoperative overall morbidity rate,length of post-operative hospital stay and mean tumor size.Results:Thirteen studies, involving 998 patients, were included in meta-analysis. There were705 LS and 293 RS.There were no significant differences between the two groups in estimated blood loss( MD=10.04, 95%CI=-10.20 ~ 30.28, P=0.33), length of post-operative hospital stay(MD=-0.01,95%CI:-0.17~0.15,P=0.90) and conversion rate(OR=1.57,95%CI:0.95~2.60,P=0.08); RALR had a lower postoperative overall morbidity rate(OR=0.59,95%CI:0.36~0.97,P=0.04) and a higher R1 resection rate(OR=1.99, 95%CI : 1.08 ~ 3.67, P=0.03).Among all of the complications,the occruence rate of postoperative bleeding(OR=0.42,95%CI:0.19~0.93,P=0.03) and biliary leakage rates(OR=0.26,95%CI:0.07~0.95,P=0.04) were higer in LRL.RALR had a lager mean tumor size and greater cost than LLR.Conclusion:RALR in the treatment of hepatic neoplasms show better safety and efficacy than LLR and robot assisted surgery system greatly extend hepatectomy surgery indications.RALR LLR can reduce postoperative overall morbidity rate, postoperative bleeding rate and postoperative biliary fistula rate. There was no difference in intraoperative blood loss.RALR improve the rate of R1 resection compared to LLR.There was no significant difference in operation time, conversion to open rate and length of post-operative hospital stay. With further improvement of equipment and technology,the advantages could be more obvious.