机器人辅助与腹腔镜胰十二指肠切除术治疗胰腺及壶腹周围肿瘤的Meta分析

Robotic versus laparoscopic pancreaticoduodenectomy for pancreatic and periampullary tumors: a meta-analysis.

作者信息

Tang Gang, Chen Fang, Chen Rui, Zhou Rongxing, Zhang Jingyi

机构信息

Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Front Oncol. 2024 Nov 19;14:1486504. doi: 10.3389/fonc.2024.1486504. eCollection 2024.

OBJECTIVE

The value of robotic pancreaticoduodenectomy (RPD) compared with laparoscopic pancreaticoduodenectomy (LPD) for pancreatic and periampullary tumors is controversial. This study aims to assess the available literature and compare the short outcomes of RPD and LPD.

METHODS

The PubMed, Cochrane Library, Embase, and Web of Science databases were searched to identify available research published up to 24 July, 2024. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated.

RESULTS

Seventeen studies with a total of 9417 patients (RPD group: 3334 patients; LPD group: 6083 patients) were included in this meta-analysis. The RPD group had lower overall morbidity (RR, 0.79), conversion (RR, 0.29) and blood transfusion rates (RR, 0.61), shorter length of stay (MD, -0.72 days), and higher number of harvested lymph nodes (MD, 0.62) than the LPD group. There were no significant differences in 90-day mortality (RR, 0.89), major complications (RR, 0.87), operative time (MD, -3.74 mins), blood loss (MD, -24.14 mL), reoperation (RR, 0.94), bile leak (RR, 0.62), postoperative pancreatic hemorrhage (RR, 0.96), postoperative pancreatic fistula (RR, 0.74), delayed gastric emptying (RR, 1.24), and R0 resection (RR, 1.00) between the groups.

CONCLUSIONS

Compared with LPD, RPD for pancreatic and periampullary tumors could be safe and effective, and it has superior surgical outcomes. Further randomized controlled trials to verify the potential advantages of RPD over LPD are necessary.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=581133, identifier CRD42024581133.

目的

机器人胰十二指肠切除术（RPD）与腹腔镜胰十二指肠切除术（LPD）治疗胰腺及壶腹周围肿瘤的价值存在争议。本研究旨在评估现有文献并比较RPD和LPD的短期疗效。

方法

检索PubMed、Cochrane图书馆、Embase和科学网数据库，以识别截至2024年7月24日发表的可用研究。计算风险比（RRs）和平均差（MDs）以及95%置信区间（CIs）。

结果

本荟萃分析纳入了17项研究，共9417例患者（RPD组：3334例患者；LPD组：6083例患者）。与LPD组相比，RPD组的总体发病率（RR，0.79）、中转率（RR，0.29）和输血率（RR，0.61）更低，住院时间更短（MD，-0.72天），收获的淋巴结数量更多（MD，0.62）。两组在90天死亡率（RR，0.89）、主要并发症（RR，0.87）、手术时间（MD，-3.74分钟）、失血量（MD，-24.14毫升）、再次手术（RR，0.94）、胆漏（RR，0.62）、术后胰出血（RR，0.96）、术后胰瘘（RR，0.74）、胃排空延迟（RR，1.24）和R0切除（RR，1.00）方面无显著差异。