General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou, 730000, China.
Department of General Surgery, The First Affiliated Hospital of Soochow University, Jiangsu, 215006, China.
Asian J Surg. 2019 Jan;42(1):32-45. doi: 10.1016/j.asjsur.2018.08.011. Epub 2018 Oct 15.
Robot-assisted distal pancreatectomy (RADP) has been developed with the aim of improving surgical quality and overcoming the limitations of laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for pancreatic resections. A systematic search was performed in the PubMed, EMBASE, Cochrane Library, Web of Science, and China Biology Medicine databases up to December 2016 for studies that compared the surgical outcomes of RADP vs. LDP or ODP for pancreatic resections. The weighted mean differences, odds ratios and 95% confidence intervals were calculated, and the data were combined using the random-effects model. The GRADE system was used to interpret the primary outcomes of this meta-analysis. A total of seventeen non-randomized observational clinical studies involving 2133 patients satisfied the eligibility criteria. Compared with LDP, RADP was associated with a longer operative time (P = 0.018), a shorter hospital length of stay (P = 0.030), and a higher rate of spleen preservation (P = 0.022). Moreover, RADP was associated with a shorter hospital LOS (P = 0.014) and a lower total complication rate (P = 0.034) than ODP. We found no statistically significant differences between the techniques in the mean estimated blood loss, severe complication rate, incidence of total pancreatic fistulas or incidence of severe pancreatic fistulas. The overall quality of evidence was poor for all outcomes. This meta-analysis indicates that RADP may be safe and comparable in terms of surgical results to LDP and ODP. Further RCTs are needed to confirm the outcomes of this meta-analysis.
机器人辅助远端胰腺切除术（RADP）的发展旨在提高手术质量，并克服腹腔镜远端胰腺切除术（LDP）和开腹远端胰腺切除术（ODP）在胰腺切除方面的局限性。对PubMed、EMBASE、Cochrane 图书馆、Web of Science 和中国生物医学文献数据库进行了系统检索，以获取比较 RADP 与 LDP 或 ODP 行胰腺切除术的手术结果的研究。计算了加权均数差值、比值比和 95%置信区间，并使用随机效应模型合并数据。使用 GRADE 系统对该荟萃分析的主要结果进行解释。共有 17 项非随机观察性临床研究，涉及 2133 例患者符合纳入标准。与 LDP 相比，RADP 手术时间更长（P=0.018），住院时间更短（P=0.030），脾脏保留率更高（P=0.022）。此外，与 ODP 相比，RADP 还具有更短的住院时间（P=0.014）和更低的总并发症发生率（P=0.034）。在估计出血量、严重并发症发生率、总胰瘘发生率或严重胰瘘发生率方面，两种技术之间无统计学差异。所有结局的证据质量总体较差。本荟萃分析表明，RADP 在手术结果方面可能与 LDP 和 ODP 一样安全且可比。需要进一步的 RCT 来证实本荟萃分析的结果。
