Article record

经口机器人手术与激光手术治疗cT1-T3声门上型喉癌：比较性与非比较性研究的系统综述与荟萃分析。

Transoral robotic versus laser surgery for cT1-T3 supraglottic laryngeal cancers: a systematic review and meta-analysis of comparative and non-comparative studies.

综述 Meta咽喉科IF 4.6Q1

文献信息

PMID	42880162
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Jerome R Lechien 查看其他 21 位作者 Luigi A Vaira；Robin Baudouin；Pierre Guarino；Carlos M Chiesa-Estomba；Aliya Turayeva；Kalamkas Sagandykova；Matteo Lazzeroni；Giannicola Iannella；Aynur Aliyeva；Stephane Hans；Antonino Maniaci；Giovanni Salzano；Łukasz Woźniak；Bożena Antonowicz；Florent Carsuzaa；Giovanni Cammaroto；Nicolien Van Der Poel；Alberto M Saibene；Miguel Mayo-Yanez；Armando De Virgilio；Abdul-Latif Hamdan
作者单位	Department of Surgery, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology, Elsan Hospital, Poitiers, France; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France; Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France. Electronic address: Jerome.Lechien@umons.ac.be. 查看其他 20 条单位信息 Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.；Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France.；Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Department of Innovative Technologies in Medicine & Dentistry, University "G. D'Annunzio", and Department of Innovative Technologies in Medicine & Dentistry, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy.；Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Department of Otolaryngology-Head and Neck Surgery, Donostia University Hospital, San Sebastián, 20014, Spain; Faculty of Medicine, Deusto University, Bilbao, 48007, Spain.；Department of Otorhinolaryngology, NCJSC "Astana Medical University", Astana, Kazakhstan.；Department of Otorhinolaryngology, NpJSC "Astana Medical University", Astana, Kazakhstan.；Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology & Head and Neck Surgery, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milan, 20121, Italy.；Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Department of Sense Organs, Sapienza University of Rome, Rome, 00185, Italy.；Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Department of Surgery, Division of Otolaryngology, Denver Health Hospital, CO, USA; Neuroscience Doctoral Program, Yeditepe University, Istanbul, Türkiye.；Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France; Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France.；Department of Surgery, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France; Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Department of Medicine and Surgery, Enna Kore University, Enna, Italy.；Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy.；Department of Dental Surgery, Medical University of Bialystok, Bialystok, Poland.；Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Department of ENT - Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France.；Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Ferrara, 44121, Italy; Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.；Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Faculty of Medicine and Translational, Neurosciences University of Antwerp, Antwerp Belgium, Belgium.；Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Otolaryngology Unit, ASST Santi Paolo E Carlo, Department of Health Sciences Università Degli Studi Di Milano Milan Italy, Italy.；Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology - Head and Neck Surgery, San Rafael Hospital (HSR), A Coruña, Spain.；Department of Sense Organs, Sapienza University of Rome, Rome, 00185, Italy.；Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
期刊	Oral oncology
SCI 分区	Q1
IF	4.6
研究类型	综述 Meta · 临床
所属专科	咽喉科

中文摘要

背景： 比较经口机器人手术（TORS）与经口激光显微手术（TOLM）治疗声门上型cT1-T3喉癌的功能、肿瘤学及手术结局的文献发现。
方法： 三位独立研究者检索了PubMed、Scopus和Cochrane Library，纳入报告TOLM和TORS肿瘤学、功能及手术（并发症）结局的论文。结局在对照（直接）研究中进行了统计比较，并在单臂队列研究之间进行了间接比较。
结果： 共纳入50项研究（2,644例患者）：19项单臂TORS研究（n=615）、27项单臂TOLM研究（n=1,122）和4项比较性研究（n=907）。TORS术后合并阳性切缘率为7.3%（95%CI，4.3-12.0），TOLM术后为12.7%（8.6-18.3）（P=0.08）；比较性荟萃分析得出风险比为0.65（0.21-1.99；P=0.45），同样非显著地倾向于TORS。术后出血（5.8%对6.4%；P=0.79）或永久性胃造瘘（7.4%对4.8%；P=0.33）方面未发现差异。永久性气管造瘘在两组中均罕见（1.6%对1.3%），喉保留率分别达到99.6%和93.0%。由于定义异质性，TOLM的并发症率无法合并（I2=87.0%）。TOLM系列的5年总生存率为72.6%（65.8-78.4），TORS无法合并。中位随访时间分别为26个月和50个月。
结论： TORS和TOLM在cT1-T3声门上型喉鳞状细胞癌中提供了目前相当的肿瘤学、手术和功能结局。直接和间接证据均趋向于TORS在切缘方面有非显著优势。文献中明显的差异更可能反映病例组合、时代、随访时长和结局定义，而非手术技术本身。迫切需要在匹配人群中进行随机比较。

英文摘要

BACKGROUND: To compare literature findings about functional, oncological and surgical outcomes of transoral robotic (TORS) versus transoral laser microsurgery (TOLM) for supraglottic cT1-T3 laryngeal cancers.
METHODS: Three independent investigators conducted a PubMed, Scopus, and Cochrane Library search for papers reporting oncological, functional and surgical (complications) outcomes of TOLM and TORS. Outcomes were statistically compared considering controlled (direct) studies, and indirectly between single-arm cohort studies.
RESULTS: Fifty studies (2,644 patients) were included: 19 single-arm TORS (n = 615), 27 single-arm TOLM (n = 1,122), and four comparative studies (n = 907). Pooled positive margins were 7.3% (95%CI, 4.3-12.0) after TORS and 12.7% (8.6-18.3) after TOLM (P = 0.08); the comparative meta-analysis yielded a risk ratio of 0.65 (0.21-1.99; P = 0.45), also favoring TORS non-significantly. No difference was found for postoperative hemorrhage (5.8% versus 6.4%; P = 0.79) or permanent gastrostomy (7.4% versus 4.8%; P = 0.33). Permanent tracheostomy was rare in both groups (1.6% versus 1.3%), and laryngeal preservation reached 99.6% and 93.0%, respectively. Complication rates were not poolable for TOLM (I2 = 87.0%) owing to definitional heterogeneity. Five-year overall survival was 72.6% (65.8-78.4) in the TOLM series and not poolable for TORS. Median follow-up was 26 versus 50 months.
CONCLUSION: TORS and TOLM provide currently comparable oncological, surgical, and functional outcomes in cT1-T3 supraglottic LSCC. Direct and indirect evidence converged toward a non-significant margin advantage for TORS. Apparent differences across the literature more plausibly reflect case mix, era, follow-up duration, and outcome definitions than the surgical technique itself. Randomized comparisons in matched populations are critically needed.