Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis

Abstract

BackgroundLaparoscopic distal pancreatectomy (LDP) reduces postoperative morbidity, hospital stay and recovery as compared with open distal pancreatectomy. Many authors believe that robotic surgery can overcome the difficulties and technical limits of LDP thanks to improved surgical manipulation and better visualization. Few studies in the literature have compared the two methods in terms of surgical and oncological outcome. The aim of this study was to compare the results of robotic (RDP) and laparoscopic distal pancreatectomy.MethodsA systematic review and meta-analysis was conducted of control studies published up to December 2016 comparing LDP and RDP. Two Reviewers independently assessed the eligibility and quality of the studies. The meta-analysis was conducted using either the fixed-effect or the random-effect model.ResultsTen studies describing 813 patients met the inclusion criteria. This meta-analysis shows that the RDP group had a significantly higher rate of spleen preservation [OR 2.89 (95% confidence interval 1.78-4.71, p < 0.0001], a lower rate of conversion to open OR 0.33 (95% CI 0.12-0.92), p = 0.003] and a shorter hospital stay [MD -0.74; (95% CI -1.34 -0.15), p = 0.01] but a higher cost than the LDP group, while other surgical outcomes did not differ between the two groups.ConclusionThis meta-analysis suggests that the RDP procedure is safe and comparable in terms of surgical results to LDP. However, even if the RDP has a higher cost compared to LDP, it increases the rate of spleen preservation, reduces the risk of conversion to open surgery and is associated to shorter length of hospital stay.

Minimally invasive distal pancreatectomy and the cost of conversion

“…We were unable to adequately compare the cost of conversion for laparoscopic and robotic procedures due to the low number of converted laparoscopic procedures (n = 3) in our cohort, but it was clear that robotic surgery had the highest operating room costs. These findings mirror those reported in recent meta-analyses, 17,18 and should be taken into consideration.…”

“…It should be noted that while our laparoscopic conversion rate of 27% is on par with other studies, and that operative times were similar to prior reports for laparoscopic and robotic pancreatectomies, 17 the robotic conversion rate was noticeably higher, at 39%. The average robotic conversion rate is reported as 8% to 9% in the literature 17,18 . In general, we feel that conversions are performed judiciously to preserve oncologic integrity and safety, which are paramount.…”

“…The average robotic conversion rate is reported as 8% to 9% in the literature. 17,18 In general, we feel that conversions are performed judiciously to preserve oncologic integrity and safety, which are paramount. Specifically, reasons for the higher robotic conversion rate may be due to attempts at robotic procedures on patients who were less than ideal, with tumors up to 13 cm.…”

Robotic-Assisted versus Laparoscopic Distal Pancreatectomy: The Results of a Case-Matched Analysis from a Tertiary Care Center

“…Consequently, clinical benefits of RDP over LDP are still under investigation and only a few studies com-paring RDP versus LDP have been published, demonstrating the safety and feasibility of the robotic approach [11,28]. Furthermore, they showed a reduced blood loss [29][30][31], an increased splenic preservation rate of 95 vs. 28% [32], and a reduced conversion to open thanks to the robotic surgery (8.2 vs. 21.6%) [33]. Moreover, the robotic approach seems to be associated with a higher margin negative resection rate (100 vs. 64%) and improved lymph node yield (19 vs. 9) versus LDP [34] thus confirming its oncologic adequacy [35].…”

Adoption of robotic technology in Turkey: A nationwide analysis on caseload and platform used

“…Robotic gastrectomy has been shown to be equally safe in oncologic terms with additional benefits of less blood loss and decreased hospi- Although the safety and benefits have been shown in many studies, 11,31 minimally invasive hepato-pancreato-biliary surgery has not been widely adopted for major operations including hemi-hepatectomy and pancreatoduodenectomy procedures. 32 The steep learning curve of hepatic 33 or pancreatic 34 resections may cause the reluctances to use minimally invasive techniques in this field.…”