Robot-assisted versus laparoscopic distal pancreatectomy: a systematic review and meta-analysis including patient subgroups

Abstract

Background Robot-assisted distal pancreatectomy (RDP) has been suggested to hold some benefits over laparoscopic distal pancreatectomy (LDP) but consensus and data on specific subgroups are lacking. This systematic review and meta-analysis reports the surgical and oncological outcome and costs between RDP and LDP including subgroups with intended spleen preservation and pancreatic ductal adenocarcinoma (PDAC). Methods Studies comparing RDP and LDP were included from PubMed, Cochrane Central Register, and Embase (inception-July 2022). Primary outcomes were conversion and unplanned splenectomy. Secondary outcomes were R0 resection, lymph node yield, major morbidity, operative time, intraoperative blood loss, in-hospital mortality, operative costs, total costs and hospital stay. Results Overall, 43 studies with 6757 patients were included, 2514 after RDP and 4243 after LDP. RDP was associated with a longer operative time (MD = 18.21, 95% CI 2.18–34.24), less blood loss (MD = 54.50, 95% CI − 84.49–24.50), and a lower conversion rate (OR = 0.44, 95% CI 0.36–0.55) compared to LDP. In spleen-preserving procedures, RDP was associated with more Kimura procedures (OR = 2.23, 95% CI 1.37–3.64) and a lower rate of unplanned splenectomies (OR = 0.32, 95% CI 0.24–0.42). In patients with PDAC, RDP was associated with a higher lymph node yield (MD = 3.95, 95% CI 1.67–6.23), but showed no difference in the rate of R0 resection (OR = 0.96, 95% CI 0.67–1.37). RDP was associated with higher total (MD = 3009.31, 95% CI 1776.37–4242.24) and operative costs (MD = 3390.40, 95% CI 1981.79–4799.00). Conclusions RDP was associated with a lower conversion rate, a higher spleen preservation rate and, in patients with PDAC, a higher lymph node yield and similar R0 resection rate, as compared to LDP. The potential benefits of RDP need to be weighed against the higher total and operative costs in future randomized trials.

Surgical Outcomes of Robotic Distal Pancreatectomy Versus Laparoscopic Distal Pancreatectomy at a Hospital in a Sparsely Populated Area

“…The review also suggested that a potential disadvantage of RDP was the longer operative time. 9 A multicenter international propensity score-matched study in 21 European centers from six countries showed a longer duration of surgery (median 285 min in RDP versus 350 min in LDP) and lower conversion rate (6.7% in RDP versus 15.2% in LDP) in association with RDP compared with LDP. Major morbidity such as postoperative pancreatic fistula and 90-day mortality were comparable between RDP and LDP.…”

“…This may result from the operative times of not only RDP but also LDP being much longer than those of high-volume centers. 2,9 Also, because of the underpopulated area, the much longer operation time in our hospital was considered to result from the presence of only one experienced hepatobiliary-pancreatic surgeon in our hospital, who always operated with non-HBP surgeons who had participated in few HBP surgeries. Compared with previous similar cohort studies, the present study showed lesser operative blood loss and lower incidence of relevant postoperative pancreatic fistula in MIDP, which were not inferior to these outcomes in high volume centers.…”

Consensus of clinical diagnosis and treatment for non-functional pancreatic neuroendocrine neoplasms with diameter <2 cm

“…[63] Additionally, robot-assisted surgery can further reduce the blood loss and conversion rate than laparoscopic surgery among certain procedures in pancreatic surgery. [64] The surgical approach should be determined according to the individual circumstances of the patient and the surgeon. In terms of surgical procedures, priority should be given to procedures that preserve pancreatic tissue and organ function.…”

Study International Multicentric Pancreatic Left Resections (SIMPLR): Does Surgical Approach Matter?

“…Until a few years ago, in the statistical comparison to open surgery, laparoscopic and robotic approaches were considered as part of a single entity, that of MIS. Given the significant differences between the two techniques in terms of costs, set-up time, and operative interface, recently the interest has shifted towards the direct comparison between laparoscopy and robotic surgery [ 9 , 10 , 11 , 12 , 13 ]. Since the first meta-analysis of 2016 investigating the difference between laparoscopic and robotic approaches for DP, with 7 studies including 568 patients [ 13 ], an increasing number of studies have been published to further investigate these 2 modalities [ 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ].…”