{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:18:44Z","timestamp":1786979924320,"version":"build-2736575974"},"reference-count":120,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T00:00:00Z","timestamp":1546560000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T00:00:00Z","timestamp":1546560000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2019,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Minimally invasive surgery has been considered as an alternative to open surgery by surgeons for colorectal cancer. However, the efficacy and safety profiles of robotic and conventional laparoscopic surgery for colorectal cancer remain unclear in the literature. The primary aim of this review was to determine whether robotic\u2010assisted laparoscopic surgery (RAS) has better clinical outcomes for colorectal cancer patients than conventional laparoscopic surgery (CLS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All randomized clinical trials (RCTs) and observational studies were systematically searched in the databases of CENTRAL, EMBASE and PubMed from their inception until January 2018. Case reports, case series and non\u2010systematic reviews were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy\u2010three studies (6 RCTs and 67 observational studies) were eligible (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009169,236) for inclusion in the data synthesis. In comparison with the CLS arm, RAS cohort was associated with a significant reduction in the incidence of conversion to open surgery (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200965%; REM: OR 0.40; 95% CI 0.30,0.53), all\u2010cause mortality (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20097%; FEM: OR 0.48; 95% CI 0.36,0.64) and wound infection (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%; FEM: OR 1.24; 95% CI 1.11,1.39). Patients who received RAS had a significantly shorter duration of hospitalization (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200994%; REM: MD \u2212\u20090.77; 95% CI 1.12, \u2212\u20090.41; day), time to oral diet (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200960%; REM: MD \u2212\u20090.43; 95% CI \u2212\u20090.64, \u2212\u20090.21; day) and lesser intraoperative blood loss (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.01,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200988%; REM: MD \u2212\u200918.05; 95% CI \u2212\u200932.24, \u2212\u20093.85; ml). However, RAS cohort was noted to require a significant longer duration of operative time (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200993%; REM: MD 38.19; 95% CI 28.78,47.60; min).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This meta\u2010analysis suggests that RAS provides better clinical outcomes for colorectal cancer patients as compared to the CLS at the expense of longer duration of operative time. However, the inconclusive trial sequential analysis and an overall low level of evidence in this review warrant future adequately powered RCTs to draw firm conclusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00268-018-04896-7","type":"journal-article","created":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T14:49:22Z","timestamp":1546613362000},"page":"1146-1161","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":81,"title":["Robotic Versus Conventional Laparoscopic Surgery for Colorectal Cancer: A Systematic Review and Meta\u2010Analysis with Trial Sequential Analysis"],"prefix":"10.1002","volume":"43","author":[{"given":"Ka Ting","family":"Ng","sequence":"first","affiliation":[{"name":"Faculty of Medicine University of Malaya Jalan Universiti 50603 Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azlan Kok Vui","family":"Tsia","sequence":"additional","affiliation":[{"name":"Department of Surgery International Medical University Bukit Jalil 50603 Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa Yu Ling","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Surgery International Medical University Bukit Jalil 50603 Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,1,4]]},"reference":[{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21442"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2016.09.019"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2016.0293"},{"key":"e_1_2_8_5_2","first-page":"1","article-title":"Comparison of outcome and cost among open, laparoscopic, and robotic surgical treatments for rectal cancer: a propensity score matched analysis of nationwide inpatient sample data","volume":"117","author":"Chen S\u2010T","year":"2017","journal-title":"J Surg Oncol"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2015.02.020"},{"key":"e_1_2_8_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLE.0000000000000331"},{"key":"e_1_2_8_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001388"},{"key":"e_1_2_8_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(05)66545\u20102"},{"key":"e_1_2_8_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.7160"},{"key":"e_1_2_8_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(14)70205\u20100"},{"key":"e_1_2_8_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(13)70016\u20100"},{"key":"e_1_2_8_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/rcs.1725"},{"key":"e_1_2_8_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.7219"},{"key":"e_1_2_8_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002321"},{"key":"e_1_2_8_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001017"},{"key":"e_1_2_8_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010013\u20103014\u20104"},{"key":"e_1_2_8_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00595\u2010015\u20101266\u20104"},{"key":"e_1_2_8_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12262\u2010015\u20101375\u20108"},{"key":"e_1_2_8_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/1477\u20107819\u201012\u2010122"},{"key":"e_1_2_8_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010016\u20104892\u2010z"},{"key":"e_1_2_8_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000011817"},{"key":"e_1_2_8_23_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g7647"},{"key":"e_1_2_8_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLE.0b013e318290158d"},{"key":"e_1_2_8_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2013.01.036"},{"key":"e_1_2_8_26_2","volume-title":"The Newcastle\u2010Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta\u2010analyses","author":"Wells G","year":"2014"},{"key":"e_1_2_8_27_2","first-page":"G1","article-title":"Quality improvement interventions to address health disparities. 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