Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Surg Oncol. 2013 Jun;20(6):1774-80. doi: 10.1245/s10434-012-2823-3. Epub 2013 Mar 17.
Robotic surgery is gaining momentum with advantages for minimally invasive management of pancreatic diseases. The objective of this meta-analysis is to compare the clinical and oncologic safety and efficacy of robotic versus open pancreatectomy.
A systematic review of the literature was performed to identify studies comparing robotic pancreatectomy and open pancreatectomy. Postoperative outcomes, intraoperative outcomes, and oncologic safety were evaluated. Meta-analysis was performed using a random-effect model.
Seven studies matched the selection criteria, including 137 (40 %) cases of robotic pancreatectomy and 203 (60 %) cases of open pancreatectomy. None of the included studies were randomized. Overall complication rate was significantly lower in robotic group [risk difference (RD) = -0.12, 95 % confidence interval (CI) -0.22 to -0.01, P = 0.03], as well as reoperation rate (RD = -0.12; CI -0.2 to -0.03, P = 0.006) and margin positivity (RD = -0.18; 95 % CI -0.3 to -0.06, P = 0.003). There was no significant difference in postoperative pancreatic fistula (POPF) incidence and mortality. The median (range) conversion rate was 10 % (0-12 %).
The results of this meta-analysis suggest that robotic pancreatectomy is as safe and efficient as, if not superior to, open surgery for patients with benign or malignant pancreatic diseases. However, the evidence is limited and more randomized controlled trials are needed to further clearly define this role.
机器人手术在微创管理胰腺疾病方面具有优势，正在逐渐普及。本荟萃分析的目的是比较机器人与开腹胰腺切除术的临床和肿瘤安全性及疗效。
系统检索文献，以确定比较机器人胰腺切除术和开腹胰腺切除术的研究。评估术后结果、术中结果和肿瘤安全性。采用随机效应模型进行荟萃分析。
符合选择标准的研究有 7 项，包括 40%（137 例）机器人胰腺切除术和 60%（203 例）开腹胰腺切除术。纳入的研究均非随机。机器人组的总体并发症发生率[风险差异（RD）=-0.12，95%置信区间（CI）-0.22 至 -0.01，P=0.03]、再次手术率（RD=-0.12；CI-0.2 至 -0.03，P=0.006）和切缘阳性率（RD=-0.18；95%CI-0.3 至 -0.06，P=0.003）均显著低于开腹组。术后胰瘘（POPF）发生率和死亡率无显著差异。中位（范围）中转率为 10%（0-12%）。
本荟萃分析结果表明，机器人胰腺切除术在治疗良性或恶性胰腺疾病患者时与开腹手术同样安全有效，如果不是更优的话。然而，证据有限，需要更多的随机对照试验来进一步明确这一作用。
