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Obese patients and robotic colorectal surgery: systematic review and meta-analysis

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Title: Obese patients and robotic colorectal surgery: systematic review and meta-analysis
Authors: Suwa, Y
Joshi, M
Poynter, L
Endo, I
Ashrafian, H
Darzi, A
Item Type: Journal Article
Abstract: Background Obesity is a major health problem, demonstrated to double the risk of colorectal cancer. The benefits of robotic colorectal surgery in obese patients remain largely unknown. This meta‐analysis evaluated the clinical and pathological outcomes of robotic colorectal surgery in obese and non‐obese patients. Methods MEDLINE, Embase, Global Health, Healthcare Management Information Consortium (HMIC) and Midwives Information and Resources Service (MIDIRS) databases were searched on 1 August 2018 with no language restriction. Meta‐analysis was performed according to PRISMA guidelines. Obese patients (BMI 30 kg/m2 or above) undergoing robotic colorectal cancer resections were compared with non‐obese patients. Included outcome measures were: operative outcomes (duration of surgery, conversion to laparotomy, blood loss), postoperative complications, hospital length of stay and pathological outcomes (number of retrieved lymph nodes, positive circumferential resection margins and length of distal margin in rectal surgery). Results A total of 131 full‐text articles were reviewed, of which 12 met the inclusion criteria and were included in the final analysis. There were 3166 non‐obese and 1420 obese patients. A longer duration of surgery was documented in obese compared with non‐obese patients (weighted mean difference −21·99 (95 per cent c.i. −31·52 to −12·46) min; P < 0·001). Obese patients had a higher rate of conversion to laparotomy than non‐obese patients (odds ratio 1·99, 95 per cent c.i. 1·54 to 2·56; P < 0·001). Blood loss, postoperative complications, length of hospital stay and pathological outcomes were not significantly different in obese and non‐obese patients. Conclusion Robotic surgery in obese patients results in a significantly longer duration of surgery and higher conversion rates than in non‐obese patients. Further studies should focus on better stratification of the obese population with colorectal disease as candidates for robotic procedures.
Issue Date: Dec-2020
Date of Acceptance: 5-Jul-2020
URI: http://hdl.handle.net/10044/1/83825
DOI: 10.1002/bjs5.50335
ISSN: 2474-9842
Publisher: Wiley Open Access
Start Page: 1042
End Page: 1053
Journal / Book Title: BJS Open
Volume: 4
Issue: 6
Copyright Statement: © 2020 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
Sponsor/Funder: National Institute of Health Research
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
SHORT-TERM OUTCOMES
BODY-MASS INDEX
LAPAROSCOPIC-ASSISTED RESECTION
RECTAL-CANCER
PATHOLOGICAL OUTCOMES
ANASTOMOTIC LEAKAGE
SURGICAL OUTCOMES
VISCERAL OBESITY
INCREASED RISK
IMPACT
Science & Technology
Life Sciences & Biomedicine
Surgery
SHORT-TERM OUTCOMES
BODY-MASS INDEX
LAPAROSCOPIC-ASSISTED RESECTION
RECTAL-CANCER
PATHOLOGICAL OUTCOMES
ANASTOMOTIC LEAKAGE
SURGICAL OUTCOMES
VISCERAL OBESITY
INCREASED RISK
IMPACT
Publication Status: Published
Online Publication Date: 2020-09-21
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine
Institute of Global Health Innovation



This item is licensed under a Creative Commons License Creative Commons