• Annals of surgery · Mar 2023

    Meta Analysis

    The RECOURSE Study: Long-term Oncologic Outcomes Associated with Robotically Assisted Minimally Invasive Procedures for Endometrial, Cervical, cOlorectal, lUng, or pRoState cancEr: a Systematic Review and meta-analysis.

    • Mario M Leitao, Usha S Kreaden, Vincent Laudone, Bernard J Park, Emmanouil P Pappou, John W Davis, David C Rice, George J Chang, Emma C Rossi, April E Hebert, April Slee, and Mithat Gonen.
    • Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY.
    • Ann. Surg. 2023 Mar 1; 277 (3): 387396387-396.

    ObjectiveTo assess long-term outcomes with robotic versus laparoscopic/thoracoscopic and open surgery for colorectal, urologic, endometrial, cervical, and thoracic cancers.BackgroundMinimally invasive surgery provides perioperative benefits and similar oncological outcomes compared with open surgery. Recent robotic surgery data have questioned long-term benefits.MethodsA systematic review and meta-analysis of cancer outcomes based on surgical approach was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using Pubmed, Scopus, and Embase. Hazard ratios for recurrence, disease-free survival (DFS), and overall survival (OS) were extracted/estimated using a hierarchical decision tree and pooled in RevMan 5.4 using inverse-variance fixed-effect (heterogeneity nonsignificant) or random effect models.ResultsOf 31,204 references, 199 were included (7 randomized, 23 database, 15 prospective, 154 retrospective studies)-157,876 robotic, 68,007 laparoscopic/thoracoscopic, and 234,649 open cases. Cervical cancer: OS and DFS were similar between robotic and laparoscopic [1.01 (0.56, 1.80), P =0.98] or open [1.18 (0.99, 1.41), P =0.06] surgery; 2 papers reported less recurrence with open surgery [2.30 (1.32, 4.01), P =0.003]. Endometrial cancer: the only significant result favored robotic over open surgery [OS; 0.77 (0.71, 0.83), P <0.001]. Lobectomy: DFS favored robotic over thoracoscopic surgery [0.74 (0.59, 0.93), P =0.009]; OS favored robotic over open surgery [0.93 (0.87, 1.00), P =0.04]. Prostatectomy: recurrence was less with robotic versus laparoscopic surgery [0.77 (0.68, 0.87), P <0.0001]; OS favored robotic over open surgery [0.78 (0.72, 0.85), P <0.0001]. Low-anterior resection: OS significantly favored robotic over laparoscopic [0.76 (0.63, 0.91), P =0.004] and open surgery [0.83 (0.74, 0.93), P =0.001].ConclusionsLong-term outcomes were similar for robotic versus laparoscopic/thoracoscopic and open surgery, with no safety signal or indication requiring further research (PROSPERO Reg#CRD42021240519).Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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