What Does the Pan-Asian Evidence for Malignant Robotic-Assisted Procedures With da Vinci Surgical Systems Say? A systematic Literature Review and Meta-Analysis
Author(s)
Ana Yankovsky, MSc1, Neera Patel, MS2, April E. Hebert, PhD2, Usha Kreaden, MSc2;
1Intuitive, Manager, Global Evidence and Access Management, Palo Alto, CA, USA, 2Intuitive Surgical, Sunnyvale, CA, USA
1Intuitive, Manager, Global Evidence and Access Management, Palo Alto, CA, USA, 2Intuitive Surgical, Sunnyvale, CA, USA
Presentation Documents
OBJECTIVES: To compare the perioperative outcomes of da Vinci robotic-assisted surgery (dV-RAS) with laparoscopic (LAP) or open surgery for 7 malignant procedures in the Asian population.
METHODS: Following PRISMA and PROSPERO (Reg#CRD42023466759) guidelines, PubMed, Scopus and EMBASE databases were systematically searched from 2010 to December 31, 2022. Studies published on Asian patients were included in the analyses of radical prostatectomy, partial nephrectomy, hysterectomy, lobectomy, right colectomy, and rectal resection. Randomized, prospective, and database studies were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effect or random-effects (heterogeneity significant). ROBINS-I/RoB 2 tools were used to assess bias.
RESULTS: There were 35 eligible studies (13 randomized, 14 prospective, 8 database) representing 8 countries and 10,640 dV-RAS, 32,457 LAP, and 22,499 open surgery patients. Most studies were from China, Taiwan and Hong Kong (N=15), followed by South Korea (N=8), Japan (N=4), Australia and New Zealand (N=4), and India (N=4). Compared to LAP, dV-RAS patients were less likely to have a conversion (OR=0.32[0.22,0.45],p<0.01), a blood transfusion (OR=0.54[0.31,0.93],p=0.03), a 30-day post-operative complication (OR=0.66[0.52,0.85],p<0.01), or a death within 30-days (OR=0.37[0.15,0.92],p=0.03), and had a shorter length of stay (MD=-0.80[-1.16,-0.44],p<0.01). The dV-RAS group had similar 30-day reoperation and readmission rates as LAP, but had longer operative times (MD=22.6[4.61,40.64],p=0.01). The dV-RAS patients were less likely to receive a blood transfusion (OR=0.15[0.07,0.32],p<0.01), experience a 30-day postoperative complication (OR=0.43 [0.26, 0.77],p<0.01), or be readmitted to the hospital (OR=0.53[0.30,0.93],p=0.03), and had a shorter length of hospital stay (MD=-2.29[-3.17,-1.42],p<0.01) when compared to open surgery. The dV-RAS group had similar operative times and 30-day reoperation and mortality rates as the open approach.
CONCLUSIONS: Our meta-analysis showed that dV-RAS may provide better perioperative clinical outcomes compared to LAP or open surgery in the Asian population. This research can help inform a regional health technology assessment. Additional research is needed to explore long-term oncological outcomes.
METHODS: Following PRISMA and PROSPERO (Reg#CRD42023466759) guidelines, PubMed, Scopus and EMBASE databases were systematically searched from 2010 to December 31, 2022. Studies published on Asian patients were included in the analyses of radical prostatectomy, partial nephrectomy, hysterectomy, lobectomy, right colectomy, and rectal resection. Randomized, prospective, and database studies were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effect or random-effects (heterogeneity significant). ROBINS-I/RoB 2 tools were used to assess bias.
RESULTS: There were 35 eligible studies (13 randomized, 14 prospective, 8 database) representing 8 countries and 10,640 dV-RAS, 32,457 LAP, and 22,499 open surgery patients. Most studies were from China, Taiwan and Hong Kong (N=15), followed by South Korea (N=8), Japan (N=4), Australia and New Zealand (N=4), and India (N=4). Compared to LAP, dV-RAS patients were less likely to have a conversion (OR=0.32[0.22,0.45],p<0.01), a blood transfusion (OR=0.54[0.31,0.93],p=0.03), a 30-day post-operative complication (OR=0.66[0.52,0.85],p<0.01), or a death within 30-days (OR=0.37[0.15,0.92],p=0.03), and had a shorter length of stay (MD=-0.80[-1.16,-0.44],p<0.01). The dV-RAS group had similar 30-day reoperation and readmission rates as LAP, but had longer operative times (MD=22.6[4.61,40.64],p=0.01). The dV-RAS patients were less likely to receive a blood transfusion (OR=0.15[0.07,0.32],p<0.01), experience a 30-day postoperative complication (OR=0.43 [0.26, 0.77],p<0.01), or be readmitted to the hospital (OR=0.53[0.30,0.93],p=0.03), and had a shorter length of hospital stay (MD=-2.29[-3.17,-1.42],p<0.01) when compared to open surgery. The dV-RAS group had similar operative times and 30-day reoperation and mortality rates as the open approach.
CONCLUSIONS: Our meta-analysis showed that dV-RAS may provide better perioperative clinical outcomes compared to LAP or open surgery in the Asian population. This research can help inform a regional health technology assessment. Additional research is needed to explore long-term oncological outcomes.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO90
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Oncology, STA: Surgery