Comparative outcomes of laparoscopic versus robotic esophagectomy: a systematic review and meta-analysis
Notice bibliographique
Résumé
Introduction: Esophagectomy is a complex surgical procedure primarily used for the treatment of esophageal malignancies and other esophageal disorders.In recent years, minimally invasive techniques, such as laparoscopic and robotic-assisted esophagectomy, have gained popularity due to their potential to reduce postoperative morbidity and enhance recovery.However, the comparative effectiveness, safety, and long-term outcomes of laparoscopic versus robotic esophagectomy remain unclear.Aim: This study aims to conduct a systematic review and meta-analysis comparing the perioperative and long-term outcomes of laparoscopic and robotic esophagectomy, with a focus on operative time, estimated blood loss, postoperative complications, length of hospital stay, lymph node yield, R0 resection rate, and oncological outcomes.Methods: A comprehensive literature search was conducted across PubMed, Embase, and the Cochrane Library from inception to January 2023.Randomized controlled trials (RCTs) and observational studies comparing laparoscopic and robotic esophagectomy were included.The primary outcomes were operative time, estimated blood loss, and postoperative complications.Secondary outcomes included length of hospital stay, lymph node yield, R0 resection rate, and long-term oncological outcomes.Metaanalyses were performed using random-effects models.Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale (NOS) for observational studies.Publication bias was evaluated using Egger's test.Statistical analyses were conducted using Stata version 16.0, with a p-value < 0.05 considered statistically significant.Results: A total of 24 studies (6 RCTs and 18 observational studies) involving 6,972 patients (3,433 robotic and 3,539 laparoscopic esophagectomy cases) were included.Robotic esophagectomy was associated with a longer operative time (mean difference [MD] = 55.52 minutes, 95% CI: 27.55 to 83.49, p < 0.001) but lower estimated blood loss (MD = -103.67ml, 95% CI: -162.78 to -44.57, p = 0.001) compared to laparoscopic esophagectomy.Postoperative complications (odds ratio [OR] = 0.78, 95% CI: 0.59 to 1.04, p = 0.091) and length of hospital stay (MD = -0.74days, 95% CI: -1.82 to 0.34, p = 0.181) were comparable between the two techniques.Robotic esophagectomy demonstrated a higher lymph node yield (MD = 2.38, 95% CI: 0.89 to 3.87, p = 0.002) and a higher R0 resection rate (OR = 1.70, 95% CI: 1.26 to 2.30, p < 0.001).Long-term oncological outcomes, including overall survival and disease-free survival, were similar between the two approaches.Egger's test indicated no significant publication bias.Conclusions: This meta-analysis demonstrates that robotic esophagectomy, despite longer operative times, offers advantages in terms of reduced blood loss, higher lymph node yield, and improved R0 resection rates compared to laparoscopic esophagectomy.Both techniques exhibit comparable postoperative complication rates, length of hospital stay, and long-term oncological outcomes.The choice between laparoscopic and robotic esophagectomy should be guided by surgeon expertise, patient-specific factors, and institutional resources.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,017 | 0,037 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,019 | 0,037 |
| Bibliométrie | 0,007 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».