Comparing oncologic and surgical outcomes of robotic and open pancreatoduodenectomy: an updated meta-analysis

To compare perioperative and oncologic outcomes of robotic pancreaticoduodenectomy (RPD) versus open pancreaticoduodenectomy (OPD) using evidence from cohort studies in a systematic review.

This is a systematic review and meta-analysis comparing outcomes between RPD and OPD. Intraoperative outcomes were operative time, estimated blood loss, lymph node yield, R0 resection, and R1 resection. Post-operative outcomes were overall complication rates, Clavien-Dindo ≥ 3, post-operative pancreatic fistula, bile leak, delayed gastric emptying, post-pancreatectomy hemorrhage, wound infection, length of stay, re-admission, re-operation, short-term mortality, and long-term mortality. Fixed-effects model or random-effects model was used to pool results. Heterogeneity was assessed using I² and Cochran's test. Publication bias was assessed using Egger's test. Influential test, outlier detection, and sensitivity analysis were conducted.

Fourteen studies met inclusion criteria, including 2862 patients (1087 in the RPD group and 1775 in the OPD group). The RPD group was associated with longer operative times, less blood loss, lower risk of overall complications, long-term mortality, and short-term mortality, and shorter length of stay. No other significant differences in outcomes were detected between the groups.

RPD achieved superior perioperative clinical outcomes and comparable oncologic outcomes. These findings suggest that robotic pancreatoduodenectomy may offer a promising alternative to open surgery.