评估达芬奇机器人辅助 (dV-RAS) 与腹腔镜/胸腔镜 (lap/VATS) 或开放肿瘤手术的 30 天结果。深部/狭窄空间的复杂手术尤其受益于 dV-RAS。先前特定程序的比较不可概括。按照 PRISMA 和 PROSPERO (Reg#CRD42023466759) 对 PubMed、Scopus 和 EMBASE 进行了系统检索（最新：2023 年 11 月 17 日）。使用固定效应或随机效应（异质性显着）将随机、前瞻性和数据库研究汇总为 R 中的比值比 (OR) 或平均差 (MD)。 ROBINS-I/RoB 2 用于评估偏倚。在 12 年期间来自 22 个国家的 56,314 份独特参考文献中，230 项研究（34 项随机研究、74 项前瞻性研究、122 个数据库）比较了 dV-RAS 与 lap/VATS 或开放手术的 7 种手术， 4个专业，代表1,194,559 dV-RAS；包括 1,095,936 圈/VATS 和 1,625,320 个开放病例。 dV-RAS 的手术时间长于 lap/VATS (MD:17.73min [9.80,25.67], P<0.01) 和开放手术 (MD:40.92min [28.83,53.00], P<0.01)，而住院时间则比 lap/VATS 长。较短（膝/VATS MD：-0.51d [-0.64，-0.38]，P<0.01；开放式MD：-1.85d [-2.09，-1.62]，P<0.01）并且失血量比开放式（MD： -293.44毫升[-359.53，-227.35]）。 dV-RAS 转换 (OR:0.44 [0.40,0.49], P<0.01)、输血 (OR:0.79 [0.72,0.88], P<0.01)、术后并发症 (OR:0.90 [0.84,0.96]、与 lap/VATS 相比，P < 0.01）、再入院（OR：0.91 [0.83，0.99]，P = 0.04）和死亡（OR：0.86 [0.81，0.92]，P <0.01）以及更少的输血（OR：0.25 [ 0.21，0.30]，P<0.01），术后并发症（OR：0.56 [0.52，0.61]，P<0.01），再入院（OR：0.71 [0.63，0.81]，P<0.01），再次手术（OR：0.89 [0.81） ，0.97]，P<0.01）和死亡（OR：0.54 [0.47，0.63]，P<0.01）与开放手术相比。 dV-RAS 和 lap/VATS 的失血量（MD：-12.26mL [-29.44,4.91]，P=0.16）和再次手术（OR：1.03 [0.95,1.11]，P=0.48）相似。存在显着的异质性。达芬奇-RAS 为肿瘤学手术和研究设计带来了好处。这些结果为考虑 dV-RAS 的多专业护理决策者提供了临床证据。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

To assess 30-day outcomes of da Vinci robotic-assisted (dV-RAS) versus laparoscopic/thoracoscopic (lap/VATS) or open oncologic surgery.Complex procedures in deep/narrow spaces especially benefit from dV-RAS. Prior procedure-specific comparisons are not generalizable.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.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.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.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.