Laparoscopic versus robotic right colectomy with extra-corporeal or intra-corporeal anastomosis: a systematic review and
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SYSTEMATIC REVIEWS AND META-ANALYSES
Laparoscopic versus robotic right colectomy with extra-corporeal or intra-corporeal anastomosis: a systematic review and meta-analysis Pietro Genova 1 & Gianni Pantuso 2 & Calogero Cipolla 2 & Mario Adelfio Latteri 2 & Solafah Abdalla 3 & Jean-Christophe Paquet 4 & Francesco Brunetti 5 & Nicola de’Angelis 5 & Salomone Di Saverio 6 Received: 23 July 2020 / Accepted: 2 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The aim of the present systematic review and meta-analysis is to compare laparoscopic right colectomy (LRC) versus robotic right colectomy (RRC) using homogeneous subgroup analyses for extra-corporeal anastomosis (EA) and intra-corporeal anastomosis (IA). Methods MEDLINE, Scopus, and Web of Science databases were searched up to April 2020 for prospective or retrospective studies comparing LRC versus RRC on at least one short- or long-term outcome. The primary outcome was the length of hospital stay (LOS). The secondary outcomes included operative and pathological results, survival, and total costs. LRC and RRC were compared using three homogeneous subgroups: without distinction by the type of anastomosis, EA only, and IA only. Pooled data analyses were performed using mean difference (MD) and random effects model. Results Thirty-seven of 448 studies were selected. The included patients were 21,397 for the LRC group and 2796 for the RRC group. Regardless for the type of anastomosis, RRC showed shorter LOS, lower blood loss, lower conversion rate, shorter time to flatus, and lower overall complication rate compared with LRC, but longer operative time and higher total costs. In the EA subgroup, RRC showed similar LOS, longer operative time, and higher costs compared with LRC, the other outcomes being similar. In the IA subgroup, RRC showed shorter LOS and longer operative time compared with LRC, with no difference for the remaining outcomes. Conclusions Most included articles are retrospective, providing low-quality evidence and limiting conclusions. The more frequent use of the IA seems to explain the advantages of RRC over LRC. Keywords Robotic right colectomy . Laparoscopic right colectomy . Intra-corporeal anastomosis . Extra-corporeal anastomosis . Meta-analysis
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-01985-x) contains supplementary material, which is available to authorized users. * Pietro Genova [email protected] 1
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Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Paolo Giaccone University Hospital, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Unit of General and Oncological Surgery, Paolo Giaccone University Hospital, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy Department of Digestive Surgery and Surgical Oncology, Bicêtre University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris-Sud
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