AUTHOR=Zhun Hong Wong Nicky , Wei Ting Yap Dominic , Lei Ng Sherryl , Yu Ning Ng Junie , James Juanita Jaslin , Wei Chieh Kow Alfred 

TITLE=Oncological outcomes in minimally invasive vs. open distal pancreatectomy: a systematic review and network meta-analysis

JOURNAL=Frontiers in Surgery

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2024.1369169

DOI=10.3389/fsurg.2024.1369169

ISSN=2296-875X

ABSTRACT=<sec><title>Background</title><p>Advancements in surgical techniques have improved outcomes in patients undergoing pancreatic surgery. To date there have been no meta-analyses comparing robotic and laparoscopic approaches for distal pancreatectomies (DP) in patients with pancreatic adenocarcinoma (PDAC). This systematic review and network meta-analysis aims to explore the oncological outcomes of laparoscopic distal pancreatectomy (LDP), robotic distal pancreatectomy (RDP) and open distal pancreatectomy (ODP).</p></sec><sec><title>Methods</title><p>A systematic search was conducted for studies reporting laparoscopic, robotic or open surgery for DP. Frequentist network meta-analysis of oncological outcomes (overall survival, resection margins, tumor recurrence, examined lymph nodes, administration of adjuvant therapy) were performed.</p></sec><sec><title>Results</title><p>Fifteen studies totalling 9,301 patients were included in the network meta-analysis. 1,946, 605 and 6,750 patients underwent LDP, RDP and ODP respectively. LDP (HR: 0.761, 95% CI: 0.642–0.901, <italic>p</italic> = 0.002) and RDP (HR: 0.757, 95% CI: 0.617–0.928, <italic>p</italic> = 0.008) were associated with overall survival (OS) benefit when compared to ODP. LDP (HR: 1.00, 95% CI: 0.793–1.27, <italic>p</italic> = 0.968) was not associated with OS benefit when compared to RDP. There were no significant differences between LDP, RDP and ODP for resection margins, tumor recurrence, examined lymph nodes and administration of adjuvant therapy.</p></sec><sec><title>Conclusion</title><p>This study highlights the longer OS in both LDP and RDP when compared to ODP for patients with PDAC.</p></sec><sec><title>Systematic Review Registration</title><p><ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/</ext-link>, PROSPERO (CRD42022336417).</p></sec>