Robotic thyroidectomy versus endoscopic thyroidectomy: a meta-analysis

World Journal of Surgical Oncology - Tập 10 - Trang 1-7 - 2012
Shuang Lin1, Zhi-Heng Chen1, Hong-Gang Jiang1, Ji-Ren Yu2
1Department of Oncological surgery, First Affiliated Hospital of Jiaxing University, Jiaxing, China
2Department of Surgery, First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, China

Tóm tắt

To conduct a meta-analysis to determine the relative merits of robotic thyroidectomy (RT) and endoscopic thyroidectomy (ET). A literature search was performed to identify comparative studies reporting peri-operative outcomes for RT and ET. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence interval (95% CI) were calculated using either a fixed-effects or a random-effects model. Six studies matched the selection criteria, which reported on 2048 subjects, of whom 978 underwent RT and 1070 underwent ET. Comparing the outcomes of RT with ET, this meta-analysis indicated that RT was associated with more complications (WMD = 1.51, 95% CI 1.18 to 1.94) and greater amount of drainage fluid (WMD = 17.10, 95% CI 5.69 to 28.51). Meanwhile, operating time (WMD = 1.50, 95% CI −39.59 to 42.58), conversion (WMD = 0.63, 95% CI 0.07 to 6.17), post-operative hospital stay (WMD = −0.05; 95% CI −0.18 to 0.08), and the number of lymph nodes harvested (WMD = 0.62, 95% CI −0.29 to 1.53) were similar for both procedures. The results of this meta-analysis indicated that RT is associated with an increased risk of complications and a greater amount of drainage fluid. Therefore, RT does not appear to have any advantage over ET. Further studies are required to confirm these results.

Tài liệu tham khảo

Hüscher CS, Chiodini S, Napolitano C, Recher A: Endoscopic right thyroid lobectomy. Surg Endosc. 1997, 11 (8): 877-10.1007/s004649900476. Jeong JJ, Kang SW, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS: Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients. J Surg Oncol. 2009, 100 (6): 477-480. 10.1002/jso.21367. Ujiki MB, Sturgeon C, Denham D, Yip L, Angelos P: Minimally invasive video-assisted thyroidectomy for follicular neoplasm: is there an advantage over conventional thyroidectomy?. Ann Surg Oncol. 2006, 13 (2): 182-186. 10.1245/ASO.2006.03.057. Epub 2006 Jan 17 Chen XD, Peng B, Gong RX, Wang L, Liao B, Li CL: Endoscopic thyroidectomy: an evidence-based research on feasibility, safety and clinical effectiveness. Chin Med J (Engl). 2008, 121 (20): 2088-2094. Choi JY, Lee KE, Chung KW, Kim SW, Choe JH, Koo do H, Kim SJ, Lee J, Chung YS, Oh SK, Youn YK: Endoscopic thyroidectomy via bilateral axillo-breast approach (BABA): review of 512 cases in a single institute. Surg Endosc. 2012, 26 (4): 948-955. 10.1007/s00464-011-1973-x. Lin S, Jiang HG, Chen ZH, Zhou SY, Liu XS, Yu JR: Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer. World J Gastroenterol. 2011, 17 (47): 5214-5220. 10.3748/wjg.v17.i47.5214. Maeso S, Reza M, Mayol JA, Blasco JA, Guerra M, Andradas E, Plana MN: Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg. 2010, 252 (2): 254-262. 10.1097/SLA.0b013e3181e6239e. Benmessaoud C, Kharrazi H, MacDorman KF: Facilitators and barriers to adopting robotic-assisted surgery: contextualizing the unified theory of acceptance and use of technology. PLoS One. 2011, 6 (1): e16395-10.1371/journal.pone.0016395. Kang SW, Park JH, Jeong JS, Lee CR, Park S, Lee SH, Jeong JJ, Nam KH, Chung WY, Park CS: Prospects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma. Surg Laparosc Endosc Percutan Tech. 2011, 21 (4): 223-229. 10.1097/SLE.0b013e3182266f31. Lee KE, Koo do H, Kim SJ, Lee J, Park KS, Oh SK, Youn YK: Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach. Surgery. 2010, 148 (6): 1207-1213. 10.1016/j.surg.2010.09.018. Yoo H, Chae BJ, Park HS, Kim KH, Kim SH, Song BJ, Jung SS, Bae JS: Comparison of surgical outcomes between endoscopic and robotic thyroidectomy. J Surg Oncol. 2012, 105 (7): 705-708. 10.1002/jso.22106. Epub 2011 Sep 27 Tae K, Bae Ji Y, Hyeok Jeong J, Rae Kim K, Hwan Choi W, Hern Ahn Y: Comparative study of robotic versus endoscopic thyroidectomy by a gasless unilateral axillo-breast or axillary approach. Head Neck. 2012, 10.1002/hed.22989. Lee S, Ryu HR, Park JH, Kim KH, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS: Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients. Ann Surg. 2011, 253 (6): 1060-1066. 10.1097/SLA.0b013e3182138b54. Lee J, Lee JH, Nah KY, Soh EY, Chung WY: Comparison of endoscopic and robotic thyroidectomy. Ann Surg Oncol. 2011, 18 (5): 1439-1446. 10.1245/s10434-010-1486-1. Lang BH, Chow MP: A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors’ initial experience. Surg Endosc. 2011, 25 (5): 1617-1623. 10.1007/s00464-010-1450-y. Kim WW, Kim JS, Hur SM, Kim SH, Lee SK, Choi JH, Kim S, Lee JE, Kim JH, Nam SJ, Yang JH, Choe JH: Is robotic surgery superior to endoscopic and open surgeries in thyroid cancer?. World J Surg. 2011, 35 (4): 779-784. 10.1007/s00268-011-0960-7. Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG: Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol. 2006, 13 (3): 413-424. 10.1245/ASO.2006.05.045. Mathurin P, Raynard B, Dharancy S, Kirzin S, Fallik D, Pruvot FR, Roumilhac D, Canva V, Paris JC, Chaput JC, Naveau S: Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma. Aliment Pharmacol Ther. 2003, 17 (10): 1247-1261. 10.1046/j.1365-2036.2003.01580.x. Zhou Y, Zhao Y, Li B, Xu D, Yin Z, Xie F, Yang J: Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma. BMC Gastroenterol. 2010, 10: 78-10.1186/1471-230X-10-78. Ng SS, Lee JF, Yiu RY, Li JC, Hon SS: Telerobotic-assisted laparoscopic abdominoperineal resection for low rectal cancer: report of the first case in Hong Kong and China with an updated literature review. World J Gastroenterol. 2007, 13 (17): 2514-2518. Mazzaferri EL: Papillary thyroid carcinoma: factors influencing prognosis and current therapy. Semin Oncol. 1987, 14 (3): 315-332. Bhattacharyya N: Surgical treatment of cervical nodal metastases in patients with papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2003, 129 (10): 1101-1104. 10.1001/archotol.129.10.1101. MacLehose RR, Reeves BC, Harvey IM, Sheldon TA, Russell IT, Black AM: A systematic review of comparisons of effect sizes derived from randomised and non-randomised studies. Health Technol Assess. 2000, 4: 1-154. Abraham NS, Byrne CJ, Young JM, Solomon MJ: Meta-analysis of well-designed nonrandomized comparative studies of surgical procedures is as good as randomized controlled trials. J Clin Epidemiol. 2010, 63: 238-245. 10.1016/j.jclinepi.2009.04.005.