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Systematic review and meta-analysis of robotic versus open pancreaticoduodenectomy

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Abstract

Background

Although robotic pancreaticoduodenectomy (RPD) has been successfully performed since 2003, its advantages over open pancreaticoduodenectomy (OPD) are still uncertain. The aim of this systematic review and meta-analysis was to compare the clinical outcomes of RPD to those of OPD.

Methods

A systematic literature review was performed to identify RPD versus OPD comparative studies published between January 2003 and January 2016. Intraoperative outcomes, post-operative outcomes and oncologic safety were evaluated. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with a 95% confidence interval (95% CI) were calculated using fixed-effect or random-effect models.

Results

Nine non-randomized observational clinical studies involving 680 patients met the inclusion criteria and involved 245 RPDs and 435 OPDs. The overall complication rate was significantly lower in RPD (OR 0.65, 95% CI 0.47–0.91, P = 0.012), as well as the margin positivity rate (OR 0.40, 95% CI 0.20–0.77, P = 0.006), the wound infection rate (OR 0.18, 95% CI 0.06–0.53, P = 0.002) and the length of hospital stay (WMD = −6.00, 95% CI −9.80 to −2.21, P = 0.002). There was no significant difference in the following: the number of lymph nodes harvested; the operation time; the reoperation rate; the incidence of delayed gastric emptying, bile leakage, pancreatic fistula and clinically significant pancreatic fistula; and mortality. The mean conversion rate was 7.3% (range 0–14%).

Conclusions

According to the results of this meta-analysis, RPD is as safe and efficient as OPD and is even favourable in terms of margin-negative resection, overall complication and wound infection rates and length of hospital stay. Given that there have not yet been any high-quality randomized controlled trials (RCTs), the evidence is still limited. Additional prospective, multi-centre RCTs are needed to further define the role of the robotic technique in PD.

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Authors and Affiliations

  1. Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi Province, China

    Long Peng, Shengrong Lin, Yong Li & Weidong Xiao

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  1. Long Peng
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  2. Shengrong Lin
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Correspondence to Weidong Xiao.

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Drs. Long Peng, Shengrong Lin, Yong Li and Weidong Xiao have no conflicts of interest or financial ties to disclose.

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Peng, L., Lin, S., Li, Y. et al. Systematic review and meta-analysis of robotic versus open pancreaticoduodenectomy. Surg Endosc 31, 3085–3097 (2017). https://doi.org/10.1007/s00464-016-5371-2

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