Intra-corporeal or extra-corporeal anastomosis after a robotic-assisted or laparoscopic right-colectomy - a systematic review and meta-analysis
EAES Academy. Yankovsky A. 07/05/22; 363119; P164
Ana Yankovsky
Contributions
Contributions
Abstract
Aim:
Studies have shown the benefits of intra-corporeal anastomosis during minimally invasive right-colectomy. However, there is limited evidence that compares the clinical outcomes of robotic-assisted intra-corporeal (R-ICA), robotic-assisted extra-corporeal (R-ECA), laparoscopic intra-corporeal (L-ICA), or laparoscopic extra-corporeal anastomosis (L-ECA) in one analysis. The aim of the systematic literature review and meta-analysis was to compare the clinical outcomes after robotic-assisted or laparoscopic right-colectomy with intra-corporeal or extra-corporeal anastomosis.
Methods:
We searched PubMed, Scopus, and Embase databases for studies published from January 1, 2010 to July 1, 2021. We included studies that compare robotic-assisted and laparoscopic right-colectomy with intra-corporeal or extra-corporeal anastomosis. Primary studies, such as randomized control trials, prospective and retrospective observational studies were included in the analysis. Two reviewers independently selected the studies, assessed the risk of bias, and performed the data extraction. Primary outcomes were: conversions, operative time, post-operative complications, surgical site infection, length of hospital stay, reoperations within 30-days, and incisional hernia within 30 days. A meta-analysis was performed using the RevMan 5.4 software. Weighted mean differences (WMD) were calculated for continuous variables and weighted odds ratios (OR) for categorical. A random effects model was used when heterogeneity was statistically significant and I2 statistic >50%, otherwise a fixed effects model was assumed.
Results:
After inclusion and exclusion criteria we identified 21 studies. All were retrospective cohort studies in design. Six studies directly compared R-ICA with R-ECA, eight compared R-ICA with L-ICA, nine compared R-ICA with L-ECA and only one study compared R-ECA with L-ECA. Robotic-ICA had longer operative times compared to L-ECA (WMD=68.34, CI=(46.98, 89.70), p<0.00001, I2=94%) and L-ICA (WMD=68.47, CI=(52.89, 84.05), p<0.00001, I2=86%), but similar to and R-ECA (WMD=18.13, CI=(-1.81, 38.07), p=0.07, I2=90%). Results of the further showed that conversion to open surgery is less likely to occur in the R-ICA group compared to L-ECA (OR= 0.23, CI=(0.12, 0.41), p<0.00001, I2=0%), L-ICA (OR=0.45, CI=(0.21, 0.95), p=0.04, I2=30%) and R-ECA (OR=0.06, CI=(0.01, 0.33), p=0.001, I2=0%). Length of hospital stay (days) was significantly shorter in the R-ICA group compared to L-ECA (WMD=-1.01, CI=(-1.65, -0.38), p=0.002, I2=69%) and L-ICA (WMD=-0.38, CI=(-0.69, -0.07), p=0.02, I2=41%), but similar when compared to R-ECA (WMD=-0.58, CI=(-1.18, 0.03), p=0.06, I2=77%). When comparing incisional hernia rate, the R-ICA approach had significantly lower rates compared to L-ECA (OR=0.25, CI=(0.07, 0.93), p=0.04, I2=0%) and R-ECA (OR=0.12, CI=(0.04, 0.36), p=0.0002, I2=0%). Six studies reported on the incisional hernia rate with most of the studies having a follow-up of 30 days after surgery. The rate of post-operative complications, reoperations and surgical site infection was similar across all groups.
Conclusion:
Robotic-assisted right colectomy with intra-corporeal anastomosis may lead to less conversion rates, shorter hospital stay and lower rates of incisional hernias. Further prospective studies with longer follow up are needed to fully understand the benefits of robotic-assisted right colectomy.
Studies have shown the benefits of intra-corporeal anastomosis during minimally invasive right-colectomy. However, there is limited evidence that compares the clinical outcomes of robotic-assisted intra-corporeal (R-ICA), robotic-assisted extra-corporeal (R-ECA), laparoscopic intra-corporeal (L-ICA), or laparoscopic extra-corporeal anastomosis (L-ECA) in one analysis. The aim of the systematic literature review and meta-analysis was to compare the clinical outcomes after robotic-assisted or laparoscopic right-colectomy with intra-corporeal or extra-corporeal anastomosis.
Methods:
We searched PubMed, Scopus, and Embase databases for studies published from January 1, 2010 to July 1, 2021. We included studies that compare robotic-assisted and laparoscopic right-colectomy with intra-corporeal or extra-corporeal anastomosis. Primary studies, such as randomized control trials, prospective and retrospective observational studies were included in the analysis. Two reviewers independently selected the studies, assessed the risk of bias, and performed the data extraction. Primary outcomes were: conversions, operative time, post-operative complications, surgical site infection, length of hospital stay, reoperations within 30-days, and incisional hernia within 30 days. A meta-analysis was performed using the RevMan 5.4 software. Weighted mean differences (WMD) were calculated for continuous variables and weighted odds ratios (OR) for categorical. A random effects model was used when heterogeneity was statistically significant and I2 statistic >50%, otherwise a fixed effects model was assumed.
Results:
After inclusion and exclusion criteria we identified 21 studies. All were retrospective cohort studies in design. Six studies directly compared R-ICA with R-ECA, eight compared R-ICA with L-ICA, nine compared R-ICA with L-ECA and only one study compared R-ECA with L-ECA. Robotic-ICA had longer operative times compared to L-ECA (WMD=68.34, CI=(46.98, 89.70), p<0.00001, I2=94%) and L-ICA (WMD=68.47, CI=(52.89, 84.05), p<0.00001, I2=86%), but similar to and R-ECA (WMD=18.13, CI=(-1.81, 38.07), p=0.07, I2=90%). Results of the further showed that conversion to open surgery is less likely to occur in the R-ICA group compared to L-ECA (OR= 0.23, CI=(0.12, 0.41), p<0.00001, I2=0%), L-ICA (OR=0.45, CI=(0.21, 0.95), p=0.04, I2=30%) and R-ECA (OR=0.06, CI=(0.01, 0.33), p=0.001, I2=0%). Length of hospital stay (days) was significantly shorter in the R-ICA group compared to L-ECA (WMD=-1.01, CI=(-1.65, -0.38), p=0.002, I2=69%) and L-ICA (WMD=-0.38, CI=(-0.69, -0.07), p=0.02, I2=41%), but similar when compared to R-ECA (WMD=-0.58, CI=(-1.18, 0.03), p=0.06, I2=77%). When comparing incisional hernia rate, the R-ICA approach had significantly lower rates compared to L-ECA (OR=0.25, CI=(0.07, 0.93), p=0.04, I2=0%) and R-ECA (OR=0.12, CI=(0.04, 0.36), p=0.0002, I2=0%). Six studies reported on the incisional hernia rate with most of the studies having a follow-up of 30 days after surgery. The rate of post-operative complications, reoperations and surgical site infection was similar across all groups.
Conclusion:
Robotic-assisted right colectomy with intra-corporeal anastomosis may lead to less conversion rates, shorter hospital stay and lower rates of incisional hernias. Further prospective studies with longer follow up are needed to fully understand the benefits of robotic-assisted right colectomy.
Aim:
Studies have shown the benefits of intra-corporeal anastomosis during minimally invasive right-colectomy. However, there is limited evidence that compares the clinical outcomes of robotic-assisted intra-corporeal (R-ICA), robotic-assisted extra-corporeal (R-ECA), laparoscopic intra-corporeal (L-ICA), or laparoscopic extra-corporeal anastomosis (L-ECA) in one analysis. The aim of the systematic literature review and meta-analysis was to compare the clinical outcomes after robotic-assisted or laparoscopic right-colectomy with intra-corporeal or extra-corporeal anastomosis.
Methods:
We searched PubMed, Scopus, and Embase databases for studies published from January 1, 2010 to July 1, 2021. We included studies that compare robotic-assisted and laparoscopic right-colectomy with intra-corporeal or extra-corporeal anastomosis. Primary studies, such as randomized control trials, prospective and retrospective observational studies were included in the analysis. Two reviewers independently selected the studies, assessed the risk of bias, and performed the data extraction. Primary outcomes were: conversions, operative time, post-operative complications, surgical site infection, length of hospital stay, reoperations within 30-days, and incisional hernia within 30 days. A meta-analysis was performed using the RevMan 5.4 software. Weighted mean differences (WMD) were calculated for continuous variables and weighted odds ratios (OR) for categorical. A random effects model was used when heterogeneity was statistically significant and I2 statistic >50%, otherwise a fixed effects model was assumed.
Results:
After inclusion and exclusion criteria we identified 21 studies. All were retrospective cohort studies in design. Six studies directly compared R-ICA with R-ECA, eight compared R-ICA with L-ICA, nine compared R-ICA with L-ECA and only one study compared R-ECA with L-ECA. Robotic-ICA had longer operative times compared to L-ECA (WMD=68.34, CI=(46.98, 89.70), p<0.00001, I2=94%) and L-ICA (WMD=68.47, CI=(52.89, 84.05), p<0.00001, I2=86%), but similar to and R-ECA (WMD=18.13, CI=(-1.81, 38.07), p=0.07, I2=90%). Results of the further showed that conversion to open surgery is less likely to occur in the R-ICA group compared to L-ECA (OR= 0.23, CI=(0.12, 0.41), p<0.00001, I2=0%), L-ICA (OR=0.45, CI=(0.21, 0.95), p=0.04, I2=30%) and R-ECA (OR=0.06, CI=(0.01, 0.33), p=0.001, I2=0%). Length of hospital stay (days) was significantly shorter in the R-ICA group compared to L-ECA (WMD=-1.01, CI=(-1.65, -0.38), p=0.002, I2=69%) and L-ICA (WMD=-0.38, CI=(-0.69, -0.07), p=0.02, I2=41%), but similar when compared to R-ECA (WMD=-0.58, CI=(-1.18, 0.03), p=0.06, I2=77%). When comparing incisional hernia rate, the R-ICA approach had significantly lower rates compared to L-ECA (OR=0.25, CI=(0.07, 0.93), p=0.04, I2=0%) and R-ECA (OR=0.12, CI=(0.04, 0.36), p=0.0002, I2=0%). Six studies reported on the incisional hernia rate with most of the studies having a follow-up of 30 days after surgery. The rate of post-operative complications, reoperations and surgical site infection was similar across all groups.
Conclusion:
Robotic-assisted right colectomy with intra-corporeal anastomosis may lead to less conversion rates, shorter hospital stay and lower rates of incisional hernias. Further prospective studies with longer follow up are needed to fully understand the benefits of robotic-assisted right colectomy.
Studies have shown the benefits of intra-corporeal anastomosis during minimally invasive right-colectomy. However, there is limited evidence that compares the clinical outcomes of robotic-assisted intra-corporeal (R-ICA), robotic-assisted extra-corporeal (R-ECA), laparoscopic intra-corporeal (L-ICA), or laparoscopic extra-corporeal anastomosis (L-ECA) in one analysis. The aim of the systematic literature review and meta-analysis was to compare the clinical outcomes after robotic-assisted or laparoscopic right-colectomy with intra-corporeal or extra-corporeal anastomosis.
Methods:
We searched PubMed, Scopus, and Embase databases for studies published from January 1, 2010 to July 1, 2021. We included studies that compare robotic-assisted and laparoscopic right-colectomy with intra-corporeal or extra-corporeal anastomosis. Primary studies, such as randomized control trials, prospective and retrospective observational studies were included in the analysis. Two reviewers independently selected the studies, assessed the risk of bias, and performed the data extraction. Primary outcomes were: conversions, operative time, post-operative complications, surgical site infection, length of hospital stay, reoperations within 30-days, and incisional hernia within 30 days. A meta-analysis was performed using the RevMan 5.4 software. Weighted mean differences (WMD) were calculated for continuous variables and weighted odds ratios (OR) for categorical. A random effects model was used when heterogeneity was statistically significant and I2 statistic >50%, otherwise a fixed effects model was assumed.
Results:
After inclusion and exclusion criteria we identified 21 studies. All were retrospective cohort studies in design. Six studies directly compared R-ICA with R-ECA, eight compared R-ICA with L-ICA, nine compared R-ICA with L-ECA and only one study compared R-ECA with L-ECA. Robotic-ICA had longer operative times compared to L-ECA (WMD=68.34, CI=(46.98, 89.70), p<0.00001, I2=94%) and L-ICA (WMD=68.47, CI=(52.89, 84.05), p<0.00001, I2=86%), but similar to and R-ECA (WMD=18.13, CI=(-1.81, 38.07), p=0.07, I2=90%). Results of the further showed that conversion to open surgery is less likely to occur in the R-ICA group compared to L-ECA (OR= 0.23, CI=(0.12, 0.41), p<0.00001, I2=0%), L-ICA (OR=0.45, CI=(0.21, 0.95), p=0.04, I2=30%) and R-ECA (OR=0.06, CI=(0.01, 0.33), p=0.001, I2=0%). Length of hospital stay (days) was significantly shorter in the R-ICA group compared to L-ECA (WMD=-1.01, CI=(-1.65, -0.38), p=0.002, I2=69%) and L-ICA (WMD=-0.38, CI=(-0.69, -0.07), p=0.02, I2=41%), but similar when compared to R-ECA (WMD=-0.58, CI=(-1.18, 0.03), p=0.06, I2=77%). When comparing incisional hernia rate, the R-ICA approach had significantly lower rates compared to L-ECA (OR=0.25, CI=(0.07, 0.93), p=0.04, I2=0%) and R-ECA (OR=0.12, CI=(0.04, 0.36), p=0.0002, I2=0%). Six studies reported on the incisional hernia rate with most of the studies having a follow-up of 30 days after surgery. The rate of post-operative complications, reoperations and surgical site infection was similar across all groups.
Conclusion:
Robotic-assisted right colectomy with intra-corporeal anastomosis may lead to less conversion rates, shorter hospital stay and lower rates of incisional hernias. Further prospective studies with longer follow up are needed to fully understand the benefits of robotic-assisted right colectomy.
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