Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States; Division of Surgical Oncology, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States.
Division of Surgical Oncology, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States.
J Gastrointest Surg. 2024 Nov;28(11):1933-1942. doi: 10.1016/j.gassur.2024.08.013. Epub 2024 Aug 15.
Whipple pancreaticoduodenectomy (PD) is a complex gastrointestinal surgery that is performed increasingly via minimally invasive approach through robotic platforms. We sought to provide a comparative review of available data regarding robot-assisted vs open PD in terms of cost-effectiveness, overall survival, and other perioperative and long-term oncologic outcomes.
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, PubMed, Scopus, and Web of Science databases were searched from 1980 to April 2024 using designated keywords. English-language studies comparing costs and oncologic outcomes of robotic vs open PDs were considered for inclusion. Reviews, abstracts, case reports, letters to the editor, and non-English articles were excluded.
A total of 1733 studies were initially identified throughout the literature search. After the removal of duplicates, title and abstract screening identified 16 studies that were included in the review. No statistically significant differences were detected in terms of short-term complications (95% CI, 0.805-1.096; P = .42), mortality (95% CI, 0.599-1.123; P = .21), and readmission (95% CI, 0.959-1.211; P = .20) among patients undergoing open vs robotic PD. Robotic PDs was associated with a slightly better overall survival (95% CI, 1.020-1.233) and higher costs (95% CI, 0.134-1.139; P = .013). Mean length of stay (LOS) was higher in the open PD group (95% CI, -0.353 to 0.189; P < .001).
Robotic-assisted PD had a slightly shorter LOS and improved overall survival. There were no differences in short-term complications, mortality, or readmission. The use of cohort studies and residual potential selection bias necessitate randomized controlled trials to define the benefit of robotic PD.
Whipple 胰十二指肠切除术（PD）是一种复杂的胃肠手术，越来越多地通过机器人平台进行微创入路。我们旨在提供关于机器人辅助与开放 PD 在成本效益、总生存率以及其他围手术期和长期肿瘤学结果方面的比较综述。
使用系统评价和荟萃分析的首选报告项目标准，从 1980 年到 2024 年 4 月，通过指定的关键词在 PubMed、Scopus 和 Web of Science 数据库中进行搜索。纳入比较机器人辅助与开放 PD 成本和肿瘤学结果的英语研究。排除综述、摘要、病例报告、给编辑的信和非英语文章。
通过文献检索，共初步确定了 1733 项研究。在去除重复项后，通过标题和摘要筛选确定了 16 项纳入综述的研究。接受开放与机器人 PD 的患者在短期并发症（95%CI，0.805-1.096；P=0.42）、死亡率（95%CI，0.599-1.123；P=0.21）和再入院率（95%CI，0.959-1.211；P=0.20）方面无统计学差异。机器人 PD 与稍高的总生存率（95%CI，1.020-1.233）和更高的成本（95%CI，0.134-1.139；P=0.013）相关。开放 PD 组的平均住院时间（LOS）较高（95%CI，-0.353 至 0.189；P<0.001）。
机器人辅助 PD 的 LOS 稍短，总生存率提高。在短期并发症、死亡率或再入院率方面没有差异。需要随机对照试验来定义机器人 PD 的获益，因为使用队列研究和残余潜在选择偏倚。
