Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.
College of Medical and Dental Sciences, University of Birmingham, UK.
Eur J Surg Oncol. 2020 Jan;46(1):6-14. doi: 10.1016/j.ejso.2019.08.007. Epub 2019 Aug 7.
Robotic pancreaticoduodenectomy (RPD) offers theoretical advantages to conventional laparoscopic surgery including improved instrument dexterity, 3D visualization and better ergonomics. This review aimed to determine if these theoretical advantages translate into improved patient outcomes comparing patients having either robotic pancreaticoduodenectomy or laparoscopic (LPD) equivalent.
A systematic literature search was conducted for studies reporting minimally invasive surgery for pancreaticoduodenectomy either robotic assisted or totally laparoscopic. Meta-analysis of intra-operative (blood loss, operating times, conversion and R0 resections) and postoperative outcomes (overall complications, pancreatic fistula, length of hospital stay) was performed using a random effects model.
This review identified 44 studies, of which six were non-randomised comparative studies including 3462 patients (1025 robotic and 2437 laparoscopic). Intraoperatively, RPD was associated with significantly lower conversion rates (OR 0.45, p < 0.001) and transfusion rates (OR: 0.60, p = 0.002) compared to LPD. However, no significant difference in blood loss (mean: 220 vs 287 mL, p = 0.1), operating time (mean: 405 vs 418 min, p = 0.3) was noted. Postoperatively RPD was associated with a shorter hospital stay (mean: 12 vs 11 days, p < 0.001) but no significant difference was noted in postoperative complications, incidence of pancreatic fistulae and R0 resection rates.
RPD appears to offer some advantages compared to conventional laparoscopic surgery, although both approaches appear to offer equivalent clinical outcomes. Importantly, the quality of evidence is generally limited to cohort studies and a high-quality randomised trial comparing both techniques is needed.
机器人胰十二指肠切除术（RPD）相对于传统腹腔镜手术具有理论优势，包括提高器械灵巧性、3D 可视化和更好的人体工程学。本综述旨在确定这些理论优势是否转化为患者结局的改善，比较接受机器人胰十二指肠切除术或腹腔镜（LPD）等效手术的患者。
系统检索了报告微创胰十二指肠切除术（机器人辅助或完全腹腔镜）的文献。使用随机效应模型对术中（出血量、手术时间、转换和 R0 切除）和术后（总并发症、胰瘘、住院时间）结局进行荟萃分析。
本综述共纳入 44 项研究，其中 6 项为非随机对照研究，共纳入 3462 例患者（1025 例机器人组和 2437 例腹腔镜组）。与 LPD 相比，RPD 术中的中转率（OR 0.45，p < 0.001）和输血率（OR：0.60，p = 0.002）显著降低。然而，两组患者的出血量（均值：220 vs 287 mL，p = 0.1）和手术时间（均值：405 vs 418 min，p = 0.3）无显著差异。术后 RPD 患者的住院时间较短（均值：12 vs 11 天，p < 0.001），但术后并发症、胰瘘发生率和 R0 切除率无显著差异。
与传统腹腔镜手术相比，RPD 似乎具有一些优势，尽管两种方法的临床结局似乎相当。重要的是，证据质量普遍限于队列研究，需要一项高质量的随机试验来比较这两种技术。
