Background
Methods
Search strategy
Inclusion and exclusion criteria
Data extraction and quality evaluation
Statistical analysis
Results
Study retrieval
Characteristics of studies
Author | Public year | Study year | Location | Stage | Type of tumor | Residual disease # | Group |
N
| Age, years* | BMI (kg/m2)* | Follow-up, months |
---|---|---|---|---|---|---|---|---|---|---|---|
Ye et al. [26] | 2017 | 2014.11–2015.11 | China | I | NA | NA | R | 9 | 45.7 ± 13.8 | 24.4 ± 4.4 | 12–24 |
L | 10 | NA | NA | 12–24 | |||||||
O | 8 | NA | NA | 12–24 | |||||||
Gallotta et al. [23] | 2016 | 2014.10–2016.4 | Italy | IA–IIIB | NA | NA | R | 32 | 49 (32–76) | 24 (17–54) | Median 38 |
L | 64 | 49 (27–73) | 24 (19–41) | Median 38 | |||||||
Bellia et al. [19] | 2016 | 2006–2014 | France, Italy | IA–IIIC | Epithelial | NA | R | 16 | 47.3 ± 12.3 | 22.3 ± 2.9 | 21.2 ± 12.7 |
L | 23 | 49.4 ± 15.9 | 25.8 ± 6.5 | 18.5 ± 8.6 | |||||||
Chen et al. [21] | 2015 | 2007.9–2015.2 | Taiwan | Recurrent | NA | NA | R | 8 | 56.3 ± 12.4 | 25.9 ± 5.6 | NA |
L | 12 | NA | |||||||||
O | 15 | NA | |||||||||
Magrina et al. [24] | 2011 | 2004.3–2008.12 | USA | I–IV | Epithelial | 21 | R | 25 | 65 (23–82) | 25.1 (18.7–35.8) | 30 |
25 | L | 27 | 59 (3–85) | 23.7 (17.6–37.7) | 54 | ||||||
67 | O | 119 | 67 (19–90) | 24.9 (16.6–38.5) | 42 | ||||||
Feuer et al. [22] | 2013 | 2008–2012 | USA | I–IV | Epithelial | 46 | R | 63 | 59.8 ± 11.8 | 27.1 ± 7.3 | 15.5 ± 12.3 |
13 | O | 26 | 55.7 ± 11.7 | 28.2 ± 6.1 | 23.5 ± 14.0 | ||||||
Magrina et al. [25] | 2013 | 2006.1–2010.12 | USA | Recurrent | NA | 7 | R | 10 | 66.0 (45.0–83.0) | 22.6 (19.7–25.5) | NA |
8 | L | 9 | 57.0 (45.0–74.0) | 24.5 (19.9–2.7) | NA | ||||||
24 | O | 33 | 62.0 (39.0–80.0) | 25.9 (18.5–41.2) | NA | ||||||
Chen et al. [20] | 2016 | 2005–2014. | Taiwan | IA–IIIC | Epithelial | 44 | R | 44 | 44.3 ± 12.3 | 22.3 ± 2.7 | 13.1 ± 5.3 |
21 | L | 21 | 43.8 ± 10.3 | 24.1 ± 4.9 | 29.6 ± 19.0 | ||||||
72 | O | 73 | 49.2 ± 12.8 | 22.9 ± 4.2 | 26.7 ± 17.7 |
Author | Year | Group |
N
| EBL, ml* | LHS, days* | OT, min* | PC | PN* | PR | OS rate | DFS rate |
---|---|---|---|---|---|---|---|---|---|---|---|
Ye et al. [26] | 2017 | R | 9 | 208.9 ± 202.7 | 11.1 ± 3.5 | 251.4 ± 58.7 | 0 | 27.8 ± 8.9 | NA | NA | NA |
L | 10 | 179.0 ± 234.0 | 15.8 ± 6.6 | 233.5 ± 75.9 | 1 | 27.3 ± 9.4 | NA | NA | NA | ||
O | 8 | 375.0 ± 353.6 | 13.1 ± 4.6 | 226.0 ± 69.8 | 2 | 25.6 ± 7.0 | NA | NA | NA | ||
Gallotta et al. [23] | 2016 | R | 32 | NA | NA | NA | 1 | NA | NA | NA | NA |
L | 64 | NA | NA | NA | 4 | NA | NA | NA | NA | ||
Bellia et al. [19] | 2016 | R | 16 | NA | NA | 270 ± 72 | 4 | NA | 1 | 16 | 15 |
L | 23 | NA | NA | 288 ± 88 | 3 | NA | 2 | 22 | 21 | ||
Chen et al. [21] | 2015 | R | 8 | 68.7 ± 53 | 4.8 ± 2.7 | NA | 1 | NA | NA | NA | NA |
L | 12 | 95.8 ± 45 | 8.4 ± 8.2 | NA | 1 | NA | NA | NA | NA | ||
O | 15 | 256.4 ± 258.5 | 16.2 ± 16.8 | NA | 6 | NA | NA | NA | NA | ||
Magrina et al. [24] | 2011 | R | 25 | 164 ± 113 | 4 ± 3 | 315 ± 102 | 6 | 11.7 ± 6.9 | NA | NA | NA |
L | 27 | 267 ± 300 | 3 ± 2 | 254 ± 83 | 1 | 13.9 ± 4.9 | NA | NA | NA | ||
O | 119 | 1307 ± 1060 | 9 ± 7 | 261 ± 77 | 40 | 13.6 ± 7.1 | NA | NA | NA | ||
Feuer et al. [22] | 2013 | R | 63 | 94.9 ± 72.9 | 2.3 ± 3.0 | 138.6 ± 38.7 | 10 | 13.3 ± 7.9 | 15 | 60 | NA |
O | 26 | 385.4 ± 219.4 | 6.2 ± 4.9 | 95.2 ± 31.3 | 6 | 10.7 ± 6.8 | 5 | 19 | NA | ||
Magrina et al. [25] | 2013 | R | 10 | 206.3 ± 249.9 | 3.4 ± 2.37 | 220.6 ± 113.6 | 2 | NA | 1 | NA | NA |
L | 9 | 127.8 ± 153.8 | 4.1 ± 5.82 | 222.3 ± 100.1 | 3 | NA | 5 | NA | NA | ||
O | 33 | 936.7 ± 824.8 | 9.9 ± 8.11 | 177.0 ± 95.8 | 14 | NA | 10 | NA | NA | ||
Chen et al. [20] | 2016 | R | 44 | 96.9 ± 83.2 | 3.5 ± 1.9 | 176.8 ± 54.3 | 0 | 24.2 ± 13.3 | NA | 44 | 43 |
L | 21 | 326.2 ± 368.7 | 5.5 ± 3.0 | 232.3 ± 85.4 | 0 | 21.4 ± 7.1 | NA | 21 | 20 | ||
O | 73 | 848.6 ± 666.9 | 9.7 ± 6.4 | 287.2 ± 144.0 | 2 | 25.9 ± 13.2 | NA | 70 | 65 |
Quality evaluation
Author | Public year | A | B | C | D | E | F | G | H | I | J | K | L | Total scores |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Ye et al. [26] | 2017 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 18 |
Gallotta et al. [23] | 2016 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 18 |
Bellia et al. [19] | 2016 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 0 | 2 | 16 |
Chen et al. [21] | 2015 | 2 | 2 | 0 | 2 | 0 | 1 | 2 | 0 | 2 | 2 | 2 | 2 | 17 |
Magrina et al. [24] | 2011 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 18 |
Feuer et al. [22] | 2013 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 1 | 2 | 17 |
Magrina et al. [25] | 2013 | 2 | 2 | 0 | 2 | 0 | 1 | 2 | 0 | 2 | 2 | 2 | 2 | 17 |
Chen et al. [20] | 2016 | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 0 | 2 | 2 | 1 | 2 | 17 |
Meta-analysis
Comparison of robotic surgery and laparoscopy
Variable | Sample size | Test of association | Model | Test of heterogeneitya,b | Egger’s testc | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
N1 | N2 | WMD/OR (95% CI) |
Z
|
P
|
Q
|
P
| I2 (%) |
t
|
P
| ||
R vs. L | |||||||||||
EBL | 96 | 79 | − 55.0871 [− 139.0087; 28.8345] | 1.29 | 0.1983 | R | 8.83 | 0.07 | 54.7 | 0.3887 | 0.7234 |
LHS | 96 | 79 | − 1.4296[− 3.5326; 0.6734] | 1.33 | 0.1827 | R | 13.06 | 0.01 | 69.4 | 0.9334 | 0.4195 |
OT | 104 | 90 | − 0.8561[− 46.3735; 44.6612] | 0.04 | 0.9706 | R | 13.4 | < 0.01 | 70.2 | 0.7602 | 0.5024 |
PC | 144 | 166 | 1.4541 [0.6502; 3.2516] | 0.91 | 0.3619 | F | 5.34 | 0.38 | 6.3 | 1.5330 | 0.2001 |
PN | 78 | 58 | − 0.5664 [− 3.1615; 2.0288] | 0.43 | 0.6688 | F | 2.78 | 0.25 | 28.2 | 0.7882 | 0.5751 |
PR | 26 | 32 | 0.2387 [0.0445; 1.2792] | 1.67 | 0.0944 | F | 1.34 | 0.25 | 25.5 | NA | NA |
OS rate | 60 | 44 | 2.2000 [0.0842; 57.4835] | 0.47 | 0.6360 | NA | NA | NA | NA | NA | NA |
DFS rate | 60 | 44 | 1.6909 [0.2572; 11.1175] | 0.55 | 0.5850 | F | 0.05 | 0.83 | 0.0 | NA | NA |
R vs. O | |||||||||||
EBL | 125 | 274 | − 521.7027 [− 809.7816; − 233.6238] | 3.55 | 0.0004 | R | 82.54 | < 0.01 | 93.9 | 1.1403 | 0.3178 |
LHS | 159 | 274 | − 5.2225 [− 6.1485; − 4.2965] | 11.05 | < 0.0001 | F | 8.36 | 0.14 | 40.2 | 0.1786 | 0.8669 |
OT | 151 | 259 | 9.8527 [− 57.0904; 76.7958] | 0.29 | 0.7730 | R | 59.75 | < 0.01 | 93.3 | 0.5645 | 0.6119 |
PC | 159 | 274 | 0.4710 [0.2537; 0.8747] | 2.38 | 0.0171 | F | 1.77 | 0.88 | 0.0 | 6.8290 | 0.0024 |
PN | 141 | 226 | 0.0048 [− 1.9418; 1.9514] | <0.01 | 0.9962 | F | 4.77 | 0.19 | 37.1 | 0.2131 | 0.8510 |
PR | 73 | 59 | 0.8506 [0.3356; 2.1562] | 0.34 | 0.7332 | F | 1.71 | 0.19 | 41.7 | NA | NA |
OS rate | 107 | 99 | 6.4355 [1.6722; 24.7678] | 2.71 | 0.0070 | F | 0.09 | 0.76 | 0.0 | NA | NA |
Comparison of robotic surgery and laparotomy
Publication bias and sensitivity analysis
Variable | Group | Effect model |
K
| WMD/OR [95% CI] |
Z
|
P
|
---|---|---|---|---|---|---|
Estimated blood loss | R vs. L | Fixed | 5 | − 39.9247 [− 78.7622; − 1.0871] | 2.01 | 0.0439 |
R vs. L | Random | 5 | − 55.0871 [− 139.0087; 28.8345] | 1.29 | 0.1983 | |
R vs. O | Fixed | 6 | − 394.2279 [− 456.4271; − 332.0286] | 12.42 | < 0.0001 | |
R vs. O | Random | 6 | − 521.7027 [− 809.7816; − 233.6238] | 3.55 | 0.0004 | |
Length of hospital stay | R vs. L | Fixed | 5 | − 0.7770 [− 1.7023; 0.1484] | 1.65 | 0.0998 |
R vs. L | Random | 5 | − 1.4296 [− 3.5326; 0.6734] | 1.33 | 0.1827 | |
R vs. O | Fixed | 6 | − 5.2225 [− 6.1485; − 4.2965] | 11.05 | < 0.0001 | |
R vs. O | Random | 6 | − 5.1505 [− 6.4793; − 3.8216] | 7.60 | < 0.0001 | |
Operating time | R vs. L | Fixed | 5 | − 7.6177 [− 31.2545; 16.0192] | 0.63 | 0.5276 |
R vs. L | Random | 5 | − 0.8561 [− 46.3735; 44.6612] | 0.04 | 0.9706 | |
R vs. O | Fixed | 5 | 24.4862 [11.5380; 37.4344] | 3.71 | 0.0002 | |
R vs. O | Random | 5 | 9.8527 [− 57.0904; 76.7958] | 0.29 | 0.7730 | |
Postoperative complication | R vs. L | Fixed | 6 | 1.4541 [0.6502; 3.2516] | 0.91 | 0.3619 |
R vs. L | Random | 6 | 1.3484 [0.5235; 3.4731] | 0.62 | 0.5357 | |
R vs. O | Fixed | 6 | 0.4710 [0.2537; 0.8747] | 2.38 | 0.0171 | |
R vs. O | Random | 6 | 0.4878 [0.2600; 0.9154] | 2.24 | 0.0254 | |
Pelvic nodes | R vs. L | Fixed | 3 | − 0.5664 [− 3.1615; 2.0288] | 0.43 | 0.6688 |
R vs. L | Random | 3 | − 0.2074 [− 3.5497; 3.1349] | 0.12 | 0.9032 | |
R vs. O | Fixed | 4 | 0.0048 [−1.9418; 1.9514] | <0.01 | 0.9962 | |
R vs. O | Random | 4 | 0.0640 [− 2.5658; 2.6937] | 0.05 | 0.9620 | |
Postoperative recurrence | R vs. L | Fixed | 2 | 0.2387 [0.0445; 1.2792] | 1.67 | 0.0944 |
R vs. L | Random | 2 | 0.2463 [0.0326; 1.8617] | 1.36 | 0.1745 | |
R vs. O | Fixed | 2 | 0.8506 [0.3356; 2.1562] | 0.34 | 0.7332 | |
R vs. O | Randomed | 2 | 0.7633 [0.1665; 3.4995] | 0.35 | 0.7281 | |
Overall survival rate | R vs. L | Fixed | 2 | 2.2000 [0.0842;5 7.4835] | 0.47 | 0.6360 |
R vs. L | Random | 2 | 2.2000 [0.0842; 57.4835] | 0.47 | 0.6360 | |
R vs. O | Fixed | 2 | 6.4355 [1.6722; 24.7678] | 2.71 | 0.0070 | |
R vs. O | Randomed | 2 | 6.6854 [1.8172; 24.5959] | 2.86 | 0.0040 | |
Disease-free survival rate | R vs. L | Fixed | 2 | 1.6909 [0.2572; 11.1175] | 0.55 | 0.5850 |
R vs. L | Randomed | 2 | 1.7085 [0.2641; 11.0547] | 0.56 | 0.5740 |