Robotic compared with open operations for cancers of the head and neck: a systematic review and meta-analysis

To compare the effectiveness and safety of robotic surgery with that of open operations for patients with cancers of the head and neck we made an electronic search of the CENTRAL, MEDLINE, EMBASE, CNKI, CBM, Opengray and Sciencepaper Online databases, and then made a manual search of specific online databases and the reference lists of relevant papers. Our most recent searches were made on 18 July 2018, and we included randomised controlled trials (RCT), case-control studies, cohort studies, and cross-sectional surveys in which robotic was compared with open surgery for cancer of the head and neck. Data from all the studies included were extracted by two independent workers. The risk ratio was chosen to measure dichotomous effects of treatment for prospective studies including RCT or cohort studies, while the odds ratio was chosen for case-control or cross-sectional studies. The weighted mean difference or standard mean difference was chosen to summarise continuous effects. A random-effects model was used for all data analyses. Thirteen studies were included: one RCT, nine cohort studies, and three cross-sectional studies. Robotic surgery was associated with fewer invaded resection margins, lower recurrence, less need for intraoperative tracheostomy, and less need and shorter duration of postoperative nasal feeding than open operations. Robotic surgery is a safe and feasible approach with remarkable superiority over open surgery for the treatment of cancers of the head and neck.