A comparison of perioperative outcomes for da Vinci robotic-assisted, laparoscopic and open surgery in oncologic procedures: a systematic literature review and meta-analysis of evidence from China
TL;DR
Comparisons with open surgery likewise favored dV-RAS for blood loss, transfusion, length of stay, and postoperative complications, and pooled evidence from China indicated that dV-RAS was associated with better outcomes than LAP/VATS or open surgery.
Abstract
The use of robot-assisted surgery (RAS) has increased markedly in China, but comparative evidence on its perioperative performance in cancer care is dispersed across specialties and study designs. This review synthesized Chinese evidence to examine the safety and effectiveness of da Vinci robot-assisted surgery (dV-RAS) relative to laparoscopic/video-assisted thoracoscopic surgery (LAP/VATS) and open surgery across seven oncologic procedures. We systematically reviewed comparative studies published from 2010 to 2024 and pooled estimates for dV-RAS versus LAP/VATS or open surgery. Prespecified perioperative outcomes were conversion to open surgery, operative time, estimated blood loss, blood transfusion, hospital length of stay, postoperative complications, readmission, reoperation, and 30-day mortality. The review included 116 studies. Relative to LAP/VATS, dV-RAS was associated with lower odds of conversion to open surgery (odds ratio [OR] 0.26; 95% confidence interval [CI] 0.21–0.33; p < 0.01), less blood loss (mean difference [MD] − 32.48 mL; 95% CI − 40.86 to − 24.11; p < 0.01), lower odds of transfusion (OR 0.61; 95% CI 0.51–0.73; p < 0.01), a shorter hospital stay (MD − 1.06 days; 95% CI − 1.30 to − 0.82; p < 0.01), fewer 30-day postoperative complications (OR 0.67; 95% CI 0.61–0.73; p < 0.01), and fewer reoperations (OR 0.62; 95% CI 0.40–0.96; p = 0.03). Comparisons with open surgery likewise favored dV-RAS for blood loss, transfusion, length of stay, and postoperative complications. Operative time, readmission, and 30-day mortality did not differ significantly between approaches. Across seven oncologic procedures, pooled evidence from China indicated that dV-RAS was associated with better outcomes on several perioperative measures than LAP/VATS or open surgery. Because between-study heterogeneity was substantial and most included studies were retrospective, the findings should be interpreted cautiously and confirmed in higher-quality prospective research.