Robotic versus Laparoscopic Distal Pancreatectomy: A Meta-Analysis of Short-Term Outcomes

Abstract

AIMTo compare the safety and efficacy of robotic-assisted distal pancreatectomy (RADP) and laparoscopic distal pancreatectomy (LDP).METHODSA literature search of PubMed, EMBASE, and the Cochrane Library database up to June 30, 2015 was performed. The following key words were used: pancreas, distal pancreatectomy, pancreatic, laparoscopic, laparoscopy, robotic, and robotic-assisted. Fixed and random effects models were applied. Study quality was assessed using the Newcastle-Ottawa Scale.RESULTSSeven non-randomized controlled trials involving 568 patients met the inclusion criteria. Compared with LDP, RADP was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, R0 resection rate, lymph nodes harvested, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.CONCLUSIONRADP is a safe and feasible alternative to LDP with regard to short-term outcomes. Further studies on the long-term outcomes of these surgical techniques are required.Core tipTo date, there is no consensus on whether laparoscopic or robotic-assisted distal pancreatectomy is more beneficial to the patient. This is the first meta-analysis to compare laparoscopic and robotic-assisted distal pancreatectomy. We found that robotic-assisted distal pancreatectomy was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.

Robotic versus laparoscopic distal pancreatectomy: A propensity score‐matched study

“…Recent meta‐analyses demonstrated that the mean operation time in RDP and LDP was 247.8 and 229.9 min, respectively . Our study showed that RDP was not associated with longer mean operative times, although dock‐the‐robot and exchange instruments may take up to 12% of operative time during robotic pancreatic procedures .…”

Association between Tumor Vasculogenic Mimicry and the Poor Prognosis of Gastric Cancer in China: An Updated Systematic Review and Meta-Analysis

“…An observed HR or OR > 1 implied a worse prognosis for the group with VM positivity, and it was considered statistically significant if the values of 95% confidence intervals did not overlap the value “1.” The heterogeneity of the included studies was evaluated by the χ 2 and I 2 tests, and P < 0.10 or I 2 > 50% was defined as heterogeneous. The fixed-effect model was used for merging the homogeneous data, and the random-effects model was suitable for merging the heterogeneous data as previously reported [26]. Publication bias was evaluated by Egger's test (STATA 14) with P < 0.05 indicating potential bias.…”

Mini-invasive distal pancreatectomy: a feasible and cost-effective technique

“…Very recently, a meta-analysis of short-term outcomes between LDP and robotic-assisted distal pancreatectomy (RADP) found a lower blood loss and a higher rate of spleen-preserving procedures in RADP. [31] Thus, the technological improvements and the magnified view during laparoscopy are crucial for control of bleeding. Nevertheless, lower rates of bleeding where found in a surgical series that excluded malignancies, suggesting a major role for the size and histology of the tumor.…”