Pancreaticoduodenectomy: robotic vs conventional laparoscopic surgery

  • Kamarajah SK & al.
  • Eur J Surg Oncol
  • 7 Aug 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Robotic pancreaticoduodenectomy (RPD) and laparoscopic pancreaticoduodenectomy (LPD) appear to be equally effective in both benign and malignant cases, but RPD offers some advantages over LPD.
  • High-quality randomised controlled trial (RCT) comparing both techniques is needed.

Why this matters

  • Evidence comparing the benefits of RPD and LPD is limited. 

Study design

  • Meta-analysis included 44 studies, of which 6 were non-randomised comparative studies (n=3462, robotic: n=1025; laparoscopic: n=2437).
  • Funding: None.

Key results

  • RPD vs LPD was associated with significantly:
    • lower conversion (OR, 0.45; 95% CI, 0.36-0.56; P<.001 and transfusion rates ci p=".002)">
    • shorter hospital stays (mean, 12 vs 11 days; P<.001 i>2=77%).
  • No significant difference was observed between RPD vs LPD in:
    • blood loss (mean, 220 vs 287 mL; P=.1),
    • operating time (mean, 405 vs 418 minutes; P=.3),
    • post-operative overall (OR, 1.04; 95% CI, 0.73-1.48; P=.8; I2=64%) and major (OR, 1.03; 95% CI, 0.71-1.48; P=.9) complications,
    • incidence of pancreatic fistulae (OR, 1.02; 95% CI, 0.81-1.29; P=.9),
    • delayed gastric emptying (OR, 0.88; 95% CI, 0.68-1.13; P=.3) and
    • R0 resection rates.

Limitations

  • Majority of the included studies were retrospective, lacking any RCT.
  • None of the studies evaluated long-term outcomes.