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Meta-Analysis
. 2017 Nov 9;17(1):105.
doi: 10.1186/s12893-017-0301-3.

Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis

Gian Piero Guerrini  1   2 , Andrea Lauretta  3 , Claudio Belluco  3 , Matteo Olivieri  3 , Marco Forlin  3 , Stefania Basso  3 , Bruno Breda  3 , Giulio Bertola  3 , Fabrizio Di Benedetto  4
Affiliations
Meta-Analysis

Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis

Gian Piero Guerrini et al. BMC Surg. .

Abstract

Background: Laparoscopic distal pancreatectomy (LDP) reduces postoperative morbidity, hospital stay and recovery as compared with open distal pancreatectomy. Many authors believe that robotic surgery can overcome the difficulties and technical limits of LDP thanks to improved surgical manipulation and better visualization. Few studies in the literature have compared the two methods in terms of surgical and oncological outcome. The aim of this study was to compare the results of robotic (RDP) and laparoscopic distal pancreatectomy.

Methods: A systematic review and meta-analysis was conducted of control studies published up to December 2016 comparing LDP and RDP. Two Reviewers independently assessed the eligibility and quality of the studies. The meta-analysis was conducted using either the fixed-effect or the random-effect model.

Results: Ten studies describing 813 patients met the inclusion criteria. This meta-analysis shows that the RDP group had a significantly higher rate of spleen preservation [OR 2.89 (95% confidence interval 1.78-4.71, p < 0.0001], a lower rate of conversion to open OR 0.33 (95% CI 0.12-0.92), p = 0.003] and a shorter hospital stay [MD -0.74; (95% CI -1.34 -0.15), p = 0.01] but a higher cost than the LDP group, while other surgical outcomes did not differ between the two groups.

Conclusion: This meta-analysis suggests that the RDP procedure is safe and comparable in terms of surgical results to LDP. However, even if the RDP has a higher cost compared to LDP, it increases the rate of spleen preservation, reduces the risk of conversion to open surgery and is associated to shorter length of hospital stay.

Keywords: Distal pancreatectomy; Laparoscopic surgery; Left pancreatectomy; Meta-analysis; Pancreatic cancer; Pancreatic resection; Review; Robotic surgery.

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Figures

Fig. 1
Fig. 1
Prisma flow chart of the selection process
Fig. 2
Fig. 2
Forest plot displaying the results of the meta-analysis regarding pancreatic fistula
Fig. 3
Fig. 3
Forest plot displaying the results of the meta-analysis regarding conversion rate
Fig. 4
Fig. 4
Forest plot displaying the results of the meta-analysis regarding spleen preservation rate
Fig. 5
Fig. 5
Forest plot displaying the results of the meta-analysis regarding hospital stay
Fig. 6
Fig. 6
Forest plot displaying the results of the meta-analysis regarding cost of operation
Fig. 7
Fig. 7
Forest plot displaying the results of the meta-analysis regarding operative time
See this image and copyright information in PMC

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