Safety and efficacy for robot-assisted versus open pancreaticoduodenectomy and distal pancreatectomy: A systematic review and meta-analysis.

BACKGROUND: This meta-analysis was conducted to compare the clinical safety and efficacy of robot-assisted pancreaticoduodenectomy (RAPD) or robot-assisted distal pancreatectomy (RADP) with open surgery.

METHODS: Multiple databases (PubMed, Medline, EMBASE and Cochrane Library) were searched to identify studies comparing the outcomes of RAPD and open pancreaticoduodenectomy (OPD) or RADP and open distal pancreatectomy (ODP) (up to December 31, 2017). Fixed and random effects models were applied according to different conditions.

RESULTS: Fifteen non-randomized controlled trials (11 RAPD vs. OPD and 4 RADP vs. ODP) involving 3690 patients were included. Robot-assisted surgery had longer operative time (RAPD vs. OPD: P = 0.0005; RADP vs. ODP: P < 0.00001) but lesser blood loss than open surgery (RAPD vs. OPD: P = 0.0009; RADP vs. ODP: P = 0.0007). RAPD was associated with less wound infection, a lower positive margin rate, lower overall complications, and faster postoperative off-bed activity. There was no significant difference in the lymph node yield, the rate of pancreatic fistula, delayed gastric emptying, reoperation, length of hospital stay and mortality between the two groups. Compared with ODP, RADP was associated with less blood transfusion, fewer lymph nodes harvested, lower complications and shorter hospital stay. There was no significant difference between the two groups in the rate of spleen preservation, positive margin, pancreatic fistula, and mortality.

CONCLUSIONS: Robot-assisted surgery is a safe and feasible alternative to OPD and ODP with regard to perioperative outcomes. However, due to the lack of high-quality randomized controlled trials, the evidence is still limited.