Robotic vs laparoscopic abdominoperineal resection for rectal cancer: A propensity score matching cohort study and meta-analysis

Table 1 Baseline characteristics after propensity score matching, n (%)

	Group RS (n = 42)	Group LS (n = 42)	P value
Age (yr)1	63.5 (55-69)	65 (57.8-72.3)	0.211
Sex			1.000
Male	32 (76.2)	32 (76.2)
Female	10 (23.8)	10 (23.8)
BMI2	22.5 (2.03)	22.6 (2.41)	0.815
COPD	8 (19)	8 (19)	1.000
Hypertension	11 (26.2)	9 (21.4)	0.608
Diabetes mellitus	2 (4.8)	4 (9.5)	0.397
Coronary artery disease	1 (2.4)	2 (4.8)	0.557
ASA Grade			0.890
1	5 (11.9)	4 (9.5)
2	22 (52.4)	24 (57.1)
3	15 (35.7)	14 (33.3)
Neoadjuvant therapy received	9 (21.4)	8 (19)	0.786
Distance between tumor and AV (cm)1	3 (2-5)	3 (2.5-4)	0.996
Stage			0.969
I	10 (23.8)	10 (23.8)
II	16 (38.1)	15 (35.7)
III	16 (38.1)	17 (40.5)

¹Values are median (interquartile range: 25^th-75^th percentile).

²Values are mean (SD).

Values in parentheses are percentages, unless indicated otherwise. ASA: American Society of Anesthesiologists physical status classification; AV: Anal verge; BMI: Body mass index; COPD: Chronic obstructive pulmonary disease; RS: Robotic surgery; LS: Laparoscopic surgery.

Table 2 Operative outcomes and postoperative complication after propensity score matching, n (%)

	Group RS (n = 42)	Group LS (n = 42)	P value
Duration of surgery (min)1	245 (191.5-295)	230 (200-286.3)	0.564
Intraoperative blood loss (ml)1	60 (50-100)	100 (50-200)	0.012
Transfusion	1 (2.4)	0 (0)	0.314
Days to first flatus1	2 (1-2)	2 (2-3)	0.023
Days to first defecation1	3 (2.8-4.3)	3 (2.8-4.3)	0.679
Reoperation	0 (0)	1 (2.4)	0.314
Mortality	0 (0)	0 (0)	-
Intensive care	0 (0)	2 (4.8)	0.152
Conventional open	0 (0)	0 (0)	-
Circumferential resection margin positive	0 (0)	1 (2.4)	0.314
Lymph nodes harvested1	15 (11-18)	13 (9-18.3)	0.309
Perineural invasion	1 (2.4)	1 (2.4)	1.000
Lymphovascular invasion	2 (4.8)	2 (4.8)	1.000
Hospital stay (d)1	9 (7.8-13)	11 (8-18)	0.044
Postoperative complications	17 (40.5)	27 (64.3)	0.029
Urinary infection	2 (4.8)	1 (2.4)	0.557
Pneumonia	1 (2.4)	1 (2.4)	1.000
Ileus	3 (7.1)	3 (7.1)	1.000
Wound infection	5 (11.9)	12 (28.6)	0.057
Intraabdominal infection	5 (11.9)	8 (19)	0.365
Urinary retention	1 (2.4)	2 (4.8)	0.557
Hospital charge (RMB)1	81886.5 (70540.5-109854.2)	70102.8 (60308.6-109415.4)	0.040

¹Values are median (interquartile range: 25^th-75^th percentile).

Values in parentheses are percentages, unless indicated otherwise. RS: Robotic surgery; LS: Laparoscopic surgery.

Table 3 Characteristics of trials included in the meta-analysis

Ref.	Country	Study design	Sample	Age	Gender (M/ F)	Outcomes	NOS
Moghadamyeghaneh et al[15], 2015	United States	Retrospective cohort study	R: 872; L: 4737	R: 64; L: 62	R: 556/316; L: 2844/1893	Hospital stay, postoperative complications, mortality	7
Kamali et al[16], 2017	United Kingdom	Retrospective case-control study	R: 11; L: 11	R: 71; L: 57	R: 7/4; L: 9/2	Postoperative complications, mortality, CRM, operating time, hospital stay, lymph nodes harvested, conversion rate	8
Gavrila et al[17], 2021	Romania	Retrospective case-control study	R: 46; L: 63	R: 62; L: 62	R: 34/12; L: 32/31	Postoperative complications, mortality, operating time, blood loss, hospital stay, conversion rate, reoperation rate	8
Kasai et al[11], 2022	Japan	Retrospective cohort study	R: 33; L: 20	R: 74; L: 78	R: 20/13; L: 16/4	Postoperative complications, CRM, operating time, blood loss, hospital stay, conversion rate, lymph nodes harvested	8
Feng et al[10], 2022	China	Randomized controlled trial	R: 174; L: 173	R: 58; L: 60	R: 108/66; L: 113/60	Postoperative complications, mortality, CRM, operating time, blood loss, hospital stay, conversion rate, reoperation rate, lymph nodes harvested	-
Gorgun et al[12], 2022	United States	Retrospective PSM	R: 34; L: 34	R: 66; L: 66	R: 25/9; L: 25/9	Postoperative complications, CRM, operating time, blood loss, hospital stay, conversion rate, reoperation rate, lymph nodes harvested	9
Current study, 2022	China	Retrospective PSM	R: 34; L: 34	R: 34; L: 34	R: 34; L: 34	Lymph nodes harvested, postoperative complications, mortality, CRM, operating time, blood loss, hospital stay, conversion rate, reoperation rate	9

CRM: Circumferential resection margin; F: Female; L: Laparoscopic abdominoperineal resection; M: Male; NOS: Newcastle-Ottawa Scale; PSM: Propensity score matching; R: Robotic abdominoperineal resection.

Table 4 Summary of results from all outcomes

Indicators	No. of studies	Events for RS	Events for LS	Effect size	95%CI
Operative time	6	-	-	17.86 min	-2.33, 38.05
Intraoperative blood loss	5	-	-	-26.36 mL	-32.02, -20.70
Postoperative complications	7	315/1211	1651/5079	0.69	0.55, 0.88
Postoperative mortality	5	4/1144	29/5025	0.71	0.26, 1.94
Reoperation	4	5/296	15/312	0.40	0.16, 1.03
Conversion to open surgery	6	6/339	17/342	0.45	0.07, 2.89
The length of stay	7	-	-	-1.51 d	-2.80, -0.21
Lymph nodes harvested	5	-	-	0.33	-1.03, 1.69
Circumferential resection margin positive	5	7/294	17/280	0.39	0.16, 0.95

RS: Robotic surgery; LS: Laparoscopic surgery.