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Review
. 2024 Oct 22;13(21):6303.
doi: 10.3390/jcm13216303.

Robotic Versus Laparoscopic Versus Open Surgery for Non-Metastatic Pancreatic Neuroendocrine Tumors (pNETs): A Systematic Review and Network Meta-Analysis

Stelios-Elion Bousi  1 , Marinos Zachiotis  1 , Michail Papapanou  1 , Maximos Frountzas  2 , Dimitrios Symeonidis  3 , Dimitrios Raptis  4 , Basilios Papaziogas  4 , Konstantinos Toutouzas  2 , Evangelos Felekouras  1 , Dimitrios Schizas  1
Affiliations
Review

Robotic Versus Laparoscopic Versus Open Surgery for Non-Metastatic Pancreatic Neuroendocrine Tumors (pNETs): A Systematic Review and Network Meta-Analysis

Stelios-Elion Bousi et al. J Clin Med. .

Abstract

Background: This systematic review, using pairwise and network meta-analyses, aimed to compare the intraoperative, short-term, and long-term postoperative outcomes of minimally invasive surgery (MIS) and open surgery (OS) for the management of pancreatic neuroendocrine tumors (pNETs). Methods: Studies reporting on the effects of robotic, laparoscopic, and open surgery on pNETs published before November 2023 on PubMed, Scopus, and CENTRAL were analyzed. Results: Thirty-two studies with 5379 patients were included in this review, encompassing 2251 patients undergoing MIS (1334 laparoscopic, 508 robotic, and 409 unspecified MIS) and 3128 patients undergoing OS for pNETs management. Pairwise meta-analysis revealed that the MIS group had a significantly shorter length of hospital stay ((a low certainty of evidence), MD of -4.87 (-6.19 to -3.56)); less intraoperative blood loss ((a low certainty of evidence), MD of -108.47 (-177.47 to -39.47)); and decreased tumor recurrence ((a high certainty of evidence), RR of 0.46, 95% CI (0.33 to 0.63)). Subgroup analysis indicated a higher R0 resection rate and prolonged operative time for laparoscopic surgery than for OS. The network meta-analysis ranked the robotic approach as superior in terms of the length of hospital stay, followed by the laparoscopic and OS arms. Furthermore, it favored both MIS approaches over OS in terms of the R0 resection rate. No significant differences were found in severe postoperative complications, postoperative fistula formation, mortality, readmission, reoperation, or conversion rates. Conclusions: This review supports the safety of MIS for the treatment of pNETs. However, the varying certainty of evidence emphasizes the need for higher-quality studies.

Keywords: laparoscopic surgery; minimally invasive surgery; neuroendocrine tumors; pancreatic surgery; robotic surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 (PRISMA 2020) flow diagram of this study.
Figure 2
Figure 2
Forest plots of pairwise meta-analysis. (A) Severe postoperative complications according to Clavien–Dindo classification—grades 3 to 5 versus 0 to 2, (B) Severe postoperative complications according to Clavien–Dindo classification—grades 3 to 5 versus 1 to 2, (C) Length of hospital stay, (D) R0 resection, (E) Tumor recurrence, (F) Spleen preservation, (G) Operative time, (H) Intraoperative blood loss, (I) 30-day mortality, (J) Postoperative fistula formation, (K) Postoperative hemorrhage, (L) Readmission, (M) Reoperation, and (N) Conversion—robotic versus laparoscopic.
Figure 2
Figure 2
Forest plots of pairwise meta-analysis. (A) Severe postoperative complications according to Clavien–Dindo classification—grades 3 to 5 versus 0 to 2, (B) Severe postoperative complications according to Clavien–Dindo classification—grades 3 to 5 versus 1 to 2, (C) Length of hospital stay, (D) R0 resection, (E) Tumor recurrence, (F) Spleen preservation, (G) Operative time, (H) Intraoperative blood loss, (I) 30-day mortality, (J) Postoperative fistula formation, (K) Postoperative hemorrhage, (L) Readmission, (M) Reoperation, and (N) Conversion—robotic versus laparoscopic.
Figure 2
Figure 2
Forest plots of pairwise meta-analysis. (A) Severe postoperative complications according to Clavien–Dindo classification—grades 3 to 5 versus 0 to 2, (B) Severe postoperative complications according to Clavien–Dindo classification—grades 3 to 5 versus 1 to 2, (C) Length of hospital stay, (D) R0 resection, (E) Tumor recurrence, (F) Spleen preservation, (G) Operative time, (H) Intraoperative blood loss, (I) 30-day mortality, (J) Postoperative fistula formation, (K) Postoperative hemorrhage, (L) Readmission, (M) Reoperation, and (N) Conversion—robotic versus laparoscopic.
Figure 3
Figure 3
Interval plots of network meta-analysis. (A) Severe complications according to Clavien–Dindo classification—grades 3 to 5 versus 0–2, (B) Length of hospital stay, (C) R0 resection, (D) Spleen preservation, (E) Operative time, (F) Tumor recurrence, (G) Intraoperative blood loss, (H) Postoperative fistula formation, (I) Postoperative hemorrhage, (J) Readmission, and (K) Reoperation.
Figure 3
Figure 3
Interval plots of network meta-analysis. (A) Severe complications according to Clavien–Dindo classification—grades 3 to 5 versus 0–2, (B) Length of hospital stay, (C) R0 resection, (D) Spleen preservation, (E) Operative time, (F) Tumor recurrence, (G) Intraoperative blood loss, (H) Postoperative fistula formation, (I) Postoperative hemorrhage, (J) Readmission, and (K) Reoperation.
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