Background: Minimally invasive surgery in the treatment of colon cancer has significantly advanced over the years. This systematic review and meta-analysis aimed to compare the operative outcomes of robotic and laparoscopic surgery in the treatment of colon cancer, focusing on operative time, hospital stay, conversion rates, anastomotic leak rates, and total number lymph node harvested. Methods: Following PRISMA guidelines, we conducted a systematic search across four databases up to January 2024, registering our protocol with PROSPERO (CRD42024513326). We included studies comparing robotic and laparoscopic surgeries for colon cancer, assessing operative time, hospital length of stay, and other perioperative outcomes. Risk of bias was evaluated using the JBI Critical Appraisal Checklist. Statistical analysis utilized a mix of fixed and random-effects models based on heterogeneity. Results: A total of 21 studies met the inclusion criteria, encompassing 50,771 patients, with 21.75% undergoing robotic surgery and 78.25% laparoscopic surgery. Robotic surgery was associated with longer operative times (SMD = −1.27,p< 0.00001) but shorter hospital stays (MD = 0.42,p= 0.003) compared to laparoscopic surgery. Conversion rates were significantly higher in laparoscopic procedures (OR = 2.02,p< 0.00001). No significant differences were found in anastomotic leak rates. A higher number of lymph nodes was harvested by robotic approach (MD = −0.65,p= 0.04). Publication bias was addressed through funnel plot analysis and Egger’s test, indicating the presence of asymmetry (p= 0.006). Conclusions: The choice of surgical method should be individualized, considering factors such as surgeon expertise, medical facilities, and patient-specific considerations. Future research should aim to elucidate long-term outcomes to further guide the clinical decision-making.
背景：近年来，微创手术在结肠癌治疗中的应用取得了显著进展。本系统综述与荟萃分析旨在比较机器人手术与腹腔镜手术治疗结肠癌的围手术期结果，重点关注手术时间、住院时长、中转开腹率、吻合口漏发生率及淋巴结清扫总数。方法：遵循PRISMA指南，我们对截至2024年1月的四个数据库进行了系统性检索，并在PROSPERO平台注册了研究方案（注册号：CRD42024513326）。纳入的研究需对比机器人手术与腹腔镜手术治疗结肠癌的效果，评估指标包括手术时间、住院时长及其他围手术期结局。采用JBI偏倚风险评估工具进行质量评价。根据异质性检验结果，统计分析采用固定效应模型与随机效应模型相结合的方法。结果：共21项研究符合纳入标准，涉及50,771例患者，其中机器人手术占21.75%，腹腔镜手术占78.25%。与腹腔镜手术相比，机器人手术时间更长（标准化均数差SMD = −1.27，p < 0.00001），但住院时间更短（均数差MD = 0.42，p = 0.003）。腹腔镜手术的中转开腹率显著更高（比值比OR = 2.02，p < 0.00001）。两组吻合口漏发生率无显著差异。机器人手术的淋巴结清扫数量更多（均数差MD = −0.65，p = 0.04）。通过漏斗图分析与Egger检验评估发表偏倚，结果显示存在不对称性（p = 0.006）。结论：手术方式的选择应个体化，综合考虑外科医生经验、医疗条件及患者具体情况等因素。未来研究需进一步阐明长期疗效，以更好地指导临床决策。
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