Armengol-García Cecilio, Blandin-Alvarez Valeria, Sharma Eshita, Salinas-Ruiz Luis Eduardo, González-Méndez Marla L, Monteiro Dos Santos Mateus, Farhan-Sayudo Iqbal, Ventura de Santana de Jesus Ana Carolina, Rizwan-Ahmed Aisha, Flores-Villalba Eduardo
Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México.
David Geffen School of Medicine at UCLA, Los Angeles, USA.
Surg Endosc. 2025 Mar;39(3):1462-1472. doi: 10.1007/s00464-024-11515-1. Epub 2025 Jan 29.
Minimally invasive pancreatoduodenectomy has gained widespread acceptance among hepatopancreatobiliary surgeons due to its demonstrated advantages in perioperative outcomes compared to the conventional open approach. This meta-analysis, along with trial sequential analysis, aimed to compare the outcomes of robotic pancreatoduodenectomy and laparoscopic pancreatoduodenectomy based on the current available evidence.
A systematic search of PubMed, Cochrane, Scopus, and Web of Science was conducted from inception to July 2024. We assessed intraoperative and postoperative outcomes, including open conversion rates, readmission, reoperation, and mortality. Additional factors, such as blood loss and the number of lymph nodes resected, were also evaluated. Quality assessment was performed using Cochrane's risk of bias tools. Subgroup analysis was conducted based on propensity score matching status, and trial sequential analysis was applied to statistically significant results on first analysis.
We meta-analyzed seventeen studies, with a total of 5,483 patients. The meta-analysis reported lower rates of open conversion (OR 0.40; 95% CI 0.26-0.61; p = < 0.001) and a higher number of lymph nodes resected (MD 3.5; 95% CI 1.45-5.55; p = 0.0008) in the RPD group. These results remained consistent after subgroup analysis. Trial sequential analysis confirmed true positive results, indicating that further studies are unnecessary to detect a significant difference. However, other perioperative outcomes did not show statistical significance and failed to reach the required information size for definitive conclusions.
This meta-analysis of non-randomized cohorts found lower rates of open conversion and a higher number of lymph nodes resected in patients undergoing robotic pancreatoduodenectomy. However, the initial analysis did not reveal statistically significant differences in transfusion rates, multivisceral and vascular resections, hemorrhage, delayed gastric emptying, mortality, or readmission rates. Future studies should focus on randomized designs, target more specific populations, and include long-term outcomes for a more comprehensive analysis.
与传统开放手术相比，微创胰十二指肠切除术因其在围手术期结果方面的优势，已在肝胆胰外科医生中得到广泛认可。本荟萃分析以及试验序贯分析旨在根据现有证据比较机器人胰十二指肠切除术和腹腔镜胰十二指肠切除术的结果。
从数据库建立至2024年7月，对PubMed、Cochrane、Scopus和Web of Science进行了系统检索。我们评估了术中及术后结果，包括开放手术转换率、再次入院、再次手术和死亡率。还评估了其他因素，如失血量和切除的淋巴结数量。使用Cochrane偏倚风险工具进行质量评估。基于倾向得分匹配状态进行亚组分析，并将试验序贯分析应用于首次分析中的统计学显著结果。
我们对17项研究进行了荟萃分析，共纳入5483例患者。荟萃分析报告机器人胰十二指肠切除术组的开放手术转换率较低（OR 0.40；95% CI 0.26 - 0.61；p = < 0.001），切除的淋巴结数量较多（MD 3.5；95% CI 1.45 - 5.55；p = 0.0008）。亚组分析后这些结果仍然一致。试验序贯分析证实了真阳性结果，表明无需进一步研究来检测显著差异。然而，其他围手术期结果未显示统计学显著性，也未达到得出确定性结论所需的信息规模。
这项对非随机队列的荟萃分析发现，接受机器人胰十二指肠切除术的患者开放手术转换率较低，切除的淋巴结数量较多。然而，初步分析未发现输血率、多脏器和血管切除、出血、胃排空延迟、死亡率或再次入院率存在统计学显著差异。未来的研究应侧重于随机设计，针对更特定的人群，并纳入长期结果以进行更全面的分析。
