Robotic pancreaticoduodenectomy provides better histopathological outcomes as compared to its open counterpart: a meta-analysis

Abstract

The aim of this meta-analysis was to evaluate whether robotic pancreaticoduodenectomy (PD) may provide better clinical and pathologic outcomes compared to its open counterpart. The Pubmed, EMBASE, and Cochrane Library were systematically searched. Overall postoperative morbidity and resection margin involvement rate were the primary endpoints. Secondary endpoints included operating time, estimated blood loss (EBL), incisional surgical site infection (SSI) rate, length of hospital stay (LOS), and number of lymph nodes harvested. Twenty-four studies totaling 12,579 patients (2,175 robotic PD and 10,404 open PD were included. Overall postoperative mortality did not significantly differ [OR (95%CI) = 0.86 (0.74, 1.01); p = 0.06]. Resection margin involvement rate was significantly lower in robotic PD [15.6% vs. 19.9%; OR (95%CI) = 0.64 (0.41, 1.00); p = 0.05; NNT = 23]. Operating time was significantly longer in robotic PD [MD (95%CI) = 75.17 (48.05, 102.28); p < 0.00001]. EBL was significantly decreased in robotic PD [MD (95%CI) = − 191.35 (− 238.12, − 144.59); p < 0.00001]. Number of lymph nodes harvested was significantly higher in robotic PD [MD (95%CI) = 2.88 (1.12, 4.65); p = 0.001]. This meta-analysis found that robotic PD provides better histopathological outcomes as compared to open PD at the cost of longer operating time. Furthermore, robotic PD did not have any detrimental impact on clinical outcomes, with lower wound infection rates.

Pancreaticoduodenectomy with right hemicolectomy for advanced malignancy: a single UK hepatopancreaticobiliary centre experience

“…Although all PD‐RC procedures in this case series were performed using an open approach, there has been a growing trend to perform PD using a minimally invasive approach (laparoscopic or robot‐assisted) which may further reduce morbidity [ 34 ]. A totally laparoscopic technique to perform PD‐RC has been described recently [ 35 ].…”

Meta-analysis of robotic versus open pancreaticoduodenectomy in all patients and pancreatic cancer patients

“…Historically, a mass of researches on OPD and RPD compared their differences in margin status, and previous meta-analysis also counted the oncological outcomes of the two groups. Except the meta-analysis of Dong et al demonstrated that the RPD group has a larger number of lymph nodes harvested and a lower resection margin involvement rate, another two metaanalyses early and this meta-analysis all reveal that there is no difference of those oncological outcomes in the two groups (28)(29)(30). The heterogeneity of lymph nodes harvested and overall complication rate is high.…”

Analysis of Oncological Outcomes After Robotic Liver Resection for Intrahepatic Cholangiocarcinoma

“…This has already been demonstrated for robotic pancreaticoduodenectomies, which appear to generate superior margins and lymph node harvests than by open approach. 18 A negative margin is of utmost importance in terms of disease-free survival (DFS) and OS. 19,20 In select cases of IHCC, the quantity of the margin is of importance, 21 particularly for mass-forming type and those without lymph node metastasis (where distant rather than local recurrence may dominate the prognostic picture).…”