AUTHOR=Fu Yibo , Qiu Jiangdong , Yu Yiqi , Wu Danning , Zhang Taiping 

TITLE=Meta-analysis of robotic versus open pancreaticoduodenectomy in all patients and pancreatic cancer patients

JOURNAL=Frontiers in Surgery

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.989065

DOI=10.3389/fsurg.2022.989065

ISSN=2296-875X

ABSTRACT=<sec><title>Purposes</title><p>To compare perioperative outcomes of robotic pancreaticoduodenectomy (RPD) to open pancreaticoduodenectomy (OPD) using evidence from cohort studies.</p></sec><sec><title>Methods</title><p>Outcomes of interest include operative time, blood loss, R0 resection rate, lymph nodes harvested, overall complication rate, pancreatic fistula rate, delayed gastric emptying rate and 90-day mortality.</p></sec><sec><title>Results</title><p>6 prospective studies and 15 retrospective studies were included. Five of these studies were limited to patients with pancreatic cancer. Operative time was significantly longer in RPD (WMD: 64.60 min; 95% CI: 26.89 to 102.21; <italic>p</italic> = 0.001). Estimated blood loss was lower in RPD (WMD: −185.44 ml; 95% CI: −239.66 to −131.21; <italic>p</italic> &lt; 0.001). Overall complication rates (OR: 0.66; 95% CI: 0.44 to 0.97; <italic>p</italic> &lt; 0.001) and pancreatic fistula rate (OR: 0.67; 95% CI: 0.55 to 0.82; <italic>p</italic> &lt; 0.001) were both lower in RPD. Length of hospital stay was longer in OPD (WMD: −1.90; 95% CI: −2.47 to −1.33). 90-day mortality was lower in RPD [odds ratio (OR): 0.77; 95% CI: 0.45 to 0.95; <italic>p</italic> = 0.025].</p></sec><sec><title>Conclusion</title><p>At current level of evidence, RPD is a safer alternative than OPD with regard to post-operative outcomes and blood loss. However, in terms of oncological outcomes RPD show no advantage over OPD, and the cost of RPD was higher. In general, RPD is now considered a reliable technology, but high-quality randomized controlled trial (RCT) studies are still needed to support this conclusion.</p></sec>