Escisión mesorrectal total laparoscópica versus asistida por robot en el tratamiento del cáncer de recto: un metaanálisis / Total laparoscopic mesorectal excision versus robot-assisted in the treatment of rectal cancer: a meta-analysis

RESUMEN

Realizamos una revisión sistemática de la literatura y un metaanálisis a través de las bases de datos MEDLINE, EMBASE y COCHRANE LIBRARY identificando los ensayos clínicos publicados entre 2005 y 2010 que comparan los resultados a corto plazo de la escisión mesorrectal total laparoscópica convencional (EMTL) y asistida por robot (EMTR) en el tratamiento del cáncer de recto no complicado. Seleccionamos 5 ensayos con un total de 380 pacientes, de los que 169 fueron sometidos a EMTR y 211 a EMTL. No hemos encontrado diferencias significativas aunque la EMTR se asocia con menor tasa de conversión, mayor margen de resección circunferencial y mayor número de ganglios linfáticos aislados, así como una menor tasa global de complicaciones. No existe evidencia de que la EMTR aporte ventajas que compensen la mayor duración de la intervención y el mayor coste del procedimiento. Son necesarios estudios prospectivos aleatorizados y con mayor número de pacientes (AU)

ABSTRACT

Abstract A systematic literature review and meta-analysis was performed using the MEDLINE, EMBASE and COCHRANE LIBRARY data bases, and identifying clinical trials, published between the years 2005 to 2010, that compared the short term results of conventional laparoscopic total mesorectal excision (L-TME) and robot-assisted total mesorectal excision (RA-TME) in the treatment of non-complicated rectal cancer. Five trials with a total of 380 patients were selected, of whom 169 were subjected to RA-TME and 211 to L-TME. No significant differences were found, although RA-TME was associated with a lower conversion rate, a greater resection margin circumference, and higher number of isolated lymph nodes, as well as a lower overall rate of complications. There was no evidence that RA-TME had advantages that compensated for the longer duration of the surgery and the higher cost of the procedure. More randomised prospective studies and a greater number of patients are needed (AU)