Lucy M De La Cruz, MD, Alvaro E Castillo, MD, Alberto Zarak, MD, Kandace M Kichler, MD, Leonardo Tamariz, MD, MPH, Srinivas Kaza, MD, FACS. University of Miami, Regional Campus, West Palm Beach, Florida.
BACKGROUND: Multiple studies provide evidence of superiority in laparoscopic compared to open colectomy. Little is known about the advantages or disadvantages of laparoscopic surgery (LC) versus robotic surgery (RC) in colon disease.
This meta-analysis compares the post-operative findings including length of stay (LOS), return of bowel function (RBF) time, and complications.
METHODS AND PROCEDURES: We performed a MEDLINE database search with secondary referencing to identify studies suitable for inclusion. Selected studies included those in which LC and RC were compared in terms of post-operative outcomes. We calculated the I squared statistic as a measure of heterogeneity. We used fixed and random effects models to calculate the standardized mean difference (SMD) and the odds ratio (OR) between the LC and RC groups.
RESULTS: Seven studies with a total of 694 cases were analyzed: 236 RC cases and 458 LC cases. Resection due to malignancy was done on 60.7% (421) of patients. No difference in LOS between RC and LC was found; however, right RC was associated with earlier RBF (p=0.01). Surgical complications were similar between both groups, with OR of ileus 1.3 (0.7-2.7) p=0.34, anastomotic leak 0.7 (0.1-3.6) p=0.75, bleeding 1.1 (0.5-2.7) p=0.68, and wound infection 1.4 (0.5-3.7) p=0.45. Data comparing number of lymph nodes was similar for both groups (p=0.74).
CONCLUSIONS: There is no statistical difference in terms of LOS and surgical complications between RC and LC, however right colectomy demonstrated earlier RBF time in the RC group.
|SMD (95% CI) p value for RBF time||SMD( 95% CI)p value for LOS|
|Both||0.35 (0.05-0.65) 0.02||0.04 (-0.89-0.94)0.92|
|Left||0.15 (-0.10-0.41) 0.25||-0.63 (-2.3-1.0) 0.47|
|Right||0.32 (0.09-0.55) <0.01||-0.09 (-0.68-0.49)0.74|