Laparoscopic versus Robotic Peripheral Pancreatectomy: A Systematic Review and Meta-analysis.

Abstract

PURPOSE: The current systematic review and meta-analysis aimed to compare Laparoscopic Distal Pancreatectomy (LPD) with Robotic Distal Pancreatectomy (RDP) in terms of length of hospital stay (LOS), perioperative, postoperative and economic parameters. METHODS: A systematic review of the literature was undertaken and data from studies fulfilling the predetermined inclusion criteria were extracted. Meta-analyses were performed to combine the results of various studies in the forms of Weighted Mean Difference (WMD), Odds Ratio (OR) and Risk Difference (RD), as appropriate. RESULTS: A significantly lower LOS (WMD:0.75, 95%CI:0.17-1.33) and longer operative duration (WMD:-28.29, 95%CI:-49.98--6.6) for the RDP group was found. The rate of open conversion was higher in the LDP group (OR:2.38, 95%CI:1.75-3.22), while the rate of spleen preservation was lower (OR:0.49, 95%CI:0.31-0.79). No significant difference was noted in the intraoperative blood loss (WMD:34, 95%CI:-10.28-78.29), postoperative blood transfusion (OR:0.99, 95%CI:0.66-1.49) and overall morbidity analyses (OR:1.08, 95%CI:0.88-1.32). A significantly higher yield of lymph nodes was achieved in the RDP group (WMD:-2.09, 95%CI:-4.17--0.01), while no differences were found when positive resection margins (RD:0.02, 95%CI:-0.02-0.07) and specimen length (WMD:0.08, 95%CI:0.42-0.58) were considered. Finally, RDP was associated with significantly higher operative (WMD:-2733.42, 95%CI:-4189.77--1277.08) and total (WMD:-3799.68, 95%CI: -4438.39--3160.98) costs. CONCLUSION: RDP seems to be a viable option for both benign and malignant pancreatic disorders, although there are concerns regarding economic parameters. Large randomized controlled trials will shed more light on the subject.