The COMPARE Study: Comparing Perioperative Outcomes of Oncologic Minimally Invasive Laparoscopic, Da Vinci Robotic, and Open Procedures

Objective: To assess 30-day outcomes of da Vinci robotic-assisted (dV-RAS) versus laparoscopic/thoracoscopic (lap/VATS) or open oncologic surgery. Summary Background Data: Complex procedures in deep/narrow spaces especially benefit from dV-RAS. Prior procedure-specific comparisons are not generalizable. Methods: PubMed, Scopus and EMBASE were systematically searched (latest: 11/17/2023) following PRISMA and PROSPERO (Reg#CRD42023466759). 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 were used to assess bias. Results: Of 56,314 unique references over 12 years from 22 countries, 230 studies (34 randomized, 74 prospective, 122 database) comparing dV-RAS to lap/VATS or open surgery across 7 procedures, 4 specialties, representing 1,194,559 dV-RAS; 1,095,936 lap/VATS and 1,625,320 open cases were included. Operative time for dV-RAS was longer than lap/VATS (MD:17.73min [9.80,25.67], P <0.01) and open surgery (MD:40.92min [28.83,53.00], P <0.01), whereas hospital stay was shorter (lap/VATS MD:-0.51d [-0.64,-0.38], P <0.01; open MD:-1.85d [-2.09,-1.62], P <0.01) and blood loss was less versus open (MD:-293.44ml [-359.53,-227.35]). There were fewer dV-RAS conversions (OR:0.44 [0.40,0.49], P <0.01), transfusions (OR:0.79 [0.72,0.88], P <0.01), postoperative complications (OR:0.90 [0.84,0.96], P <0.01), readmissions (OR:0.91 [0.83,0.99], P =0.04), and deaths (OR:0.86 [0.81,0.92], P <0.01) versus lap/VATS, and fewer transfusions (OR:0.25 [0.21,0.30], P <0.01), postoperative complications (OR:0.56 [0.52,0.61], P <0.01), readmissions (OR:0.71 [0.63,0.81], P <0.01), reoperations (OR:0.89 [0.81,0.97], P <0.01), and deaths (OR:0.54 [0.47,0.63], P <0.01) versus open surgery. Blood loss (MD:-12.26mL [-29.44,4.91], P =0.16) and reoperations (OR:1.03 [0.95,1.11], P =0.48) were similar for dV-RAS and lap/VATS. There was significant heterogeneity. Conclusions: Da Vinci -RAS confers benefits across oncological procedures and study designs. These results provide clinical evidence to multi-specialty-care decision-makers considering dV-RAS.