Abstract
The aim of this meta-analysis was to evaluate whether robotic pancreaticoduodenectomy (PD) may provide better clinical and pathologic outcomes compared to its open counterpart. The Pubmed, EMBASE, and Cochrane Library were systematically searched. Overall postoperative morbidity and resection margin involvement rate were the primary endpoints. Secondary endpoints included operating time, estimated blood loss (EBL), incisional surgical site infection (SSI) rate, length of hospital stay (LOS), and number of lymph nodes harvested. Twenty-four studies totaling 12,579 patients (2,175 robotic PD and 10,404 open PD were included. Overall postoperative mortality did not significantly differ [OR (95%CI) = 0.86 (0.74, 1.01); p = 0.06]. Resection margin involvement rate was significantly lower in robotic PD [15.6% vs. 19.9%; OR (95%CI) = 0.64 (0.41, 1.00); p = 0.05; NNT = 23]. Operating time was significantly longer in robotic PD [MD (95%CI) = 75.17 (48.05, 102.28); p < 0.00001]. EBL was significantly decreased in robotic PD [MD (95%CI) = − 191.35 (− 238.12, − 144.59); p < 0.00001]. Number of lymph nodes harvested was significantly higher in robotic PD [MD (95%CI) = 2.88 (1.12, 4.65); p = 0.001]. This meta-analysis found that robotic PD provides better histopathological outcomes as compared to open PD at the cost of longer operating time. Furthermore, robotic PD did not have any detrimental impact on clinical outcomes, with lower wound infection rates.
Highlights
Pancreatic surgery has made tremendous progress over the last several decades
The research question was formulated within the PICOTS framework as following: (P) Population: Adults older than 18 years old undergoing pancreaticoduodenectomy. (I) Intervention: robotic pancreaticoduodenectomy. (C) Comparator intervention: open pancreaticoduodenectomy. (O) Outcomes: operating time, estimated blood lost, postoperative complication rate, postoperative pancreatic fistula (POPF) rate, delayed gastric emptying rate, incisional surgical site infection rate, reoperation rate, length of hospital stay, margin involvement rate, and number of lymph nodes harvested. (T) Time: Short-term. (S) Setting: Inpatient
Resection margins are important for overall survival and locoregional recurrence, the ability to achieve R0 resection can be as low as 60% in some open cases[14,58]
Summary
With the introduction of minimally invasive techniques, adoption of laparoscopy and robotic platforms for performance of complex pancreatic surgery has evolved as well. Prior to the introduction of the robotic platform, attempts to improve surgical outcome with the use of laparoscopy did not gain widespread a doption[4,5]. Robotic platform allows performance of complex surgical cases by overcoming the limitations associated with laparoscopic surgery. Long-term outcomes of robotic surgery for pancreatic cancer is still scarce in the literature due to the limited longitudinal data available. Based on the available literature, we attempted to evaluate the role of robotic PD in comparison to open approach with a focus on short-term clinical outcomes as well as histopathological outcomes such as margin status and nodal h arvesting[14]
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