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Robot-assisted versus laparoscopic distal pancreatectomy: a systematic review and meta-analysis including patient subgroups

BACKGROUND: Robot-assisted distal pancreatectomy (RDP) has been suggested to hold some benefits over laparoscopic distal pancreatectomy (LDP) but consensus and data on specific subgroups are lacking. This systematic review and meta-analysis reports the surgical and oncological outcome and costs betw...

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Autores principales: van Ramshorst, Tess M. E., van Bodegraven, Eduard A., Zampedri, Pietro, Kasai, Meidai, Besselink, Marc G., Abu Hilal, Mohammad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10235152/
https://www.ncbi.nlm.nih.gov/pubmed/36781467
http://dx.doi.org/10.1007/s00464-023-09894-y
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author van Ramshorst, Tess M. E.
van Bodegraven, Eduard A.
Zampedri, Pietro
Kasai, Meidai
Besselink, Marc G.
Abu Hilal, Mohammad
author_facet van Ramshorst, Tess M. E.
van Bodegraven, Eduard A.
Zampedri, Pietro
Kasai, Meidai
Besselink, Marc G.
Abu Hilal, Mohammad
author_sort van Ramshorst, Tess M. E.
collection PubMed
description BACKGROUND: Robot-assisted distal pancreatectomy (RDP) has been suggested to hold some benefits over laparoscopic distal pancreatectomy (LDP) but consensus and data on specific subgroups are lacking. This systematic review and meta-analysis reports the surgical and oncological outcome and costs between RDP and LDP including subgroups with intended spleen preservation and pancreatic ductal adenocarcinoma (PDAC). METHODS: Studies comparing RDP and LDP were included from PubMed, Cochrane Central Register, and Embase (inception-July 2022). Primary outcomes were conversion and unplanned splenectomy. Secondary outcomes were R0 resection, lymph node yield, major morbidity, operative time, intraoperative blood loss, in-hospital mortality, operative costs, total costs and hospital stay. RESULTS: Overall, 43 studies with 6757 patients were included, 2514 after RDP and 4243 after LDP. RDP was associated with a longer operative time (MD = 18.21, 95% CI 2.18–34.24), less blood loss (MD = 54.50, 95% CI − 84.49–24.50), and a lower conversion rate (OR = 0.44, 95% CI 0.36–0.55) compared to LDP. In spleen-preserving procedures, RDP was associated with more Kimura procedures (OR = 2.23, 95% CI 1.37–3.64) and a lower rate of unplanned splenectomies (OR = 0.32, 95% CI 0.24–0.42). In patients with PDAC, RDP was associated with a higher lymph node yield (MD = 3.95, 95% CI 1.67–6.23), but showed no difference in the rate of R0 resection (OR = 0.96, 95% CI 0.67–1.37). RDP was associated with higher total (MD = 3009.31, 95% CI 1776.37–4242.24) and operative costs (MD = 3390.40, 95% CI 1981.79–4799.00). CONCLUSIONS: RDP was associated with a lower conversion rate, a higher spleen preservation rate and, in patients with PDAC, a higher lymph node yield and similar R0 resection rate, as compared to LDP. The potential benefits of RDP need to be weighed against the higher total and operative costs in future randomized trials. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-023-09894-y.
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spelling pubmed-102351522023-06-03 Robot-assisted versus laparoscopic distal pancreatectomy: a systematic review and meta-analysis including patient subgroups van Ramshorst, Tess M. E. van Bodegraven, Eduard A. Zampedri, Pietro Kasai, Meidai Besselink, Marc G. Abu Hilal, Mohammad Surg Endosc Review Article BACKGROUND: Robot-assisted distal pancreatectomy (RDP) has been suggested to hold some benefits over laparoscopic distal pancreatectomy (LDP) but consensus and data on specific subgroups are lacking. This systematic review and meta-analysis reports the surgical and oncological outcome and costs between RDP and LDP including subgroups with intended spleen preservation and pancreatic ductal adenocarcinoma (PDAC). METHODS: Studies comparing RDP and LDP were included from PubMed, Cochrane Central Register, and Embase (inception-July 2022). Primary outcomes were conversion and unplanned splenectomy. Secondary outcomes were R0 resection, lymph node yield, major morbidity, operative time, intraoperative blood loss, in-hospital mortality, operative costs, total costs and hospital stay. RESULTS: Overall, 43 studies with 6757 patients were included, 2514 after RDP and 4243 after LDP. RDP was associated with a longer operative time (MD = 18.21, 95% CI 2.18–34.24), less blood loss (MD = 54.50, 95% CI − 84.49–24.50), and a lower conversion rate (OR = 0.44, 95% CI 0.36–0.55) compared to LDP. In spleen-preserving procedures, RDP was associated with more Kimura procedures (OR = 2.23, 95% CI 1.37–3.64) and a lower rate of unplanned splenectomies (OR = 0.32, 95% CI 0.24–0.42). In patients with PDAC, RDP was associated with a higher lymph node yield (MD = 3.95, 95% CI 1.67–6.23), but showed no difference in the rate of R0 resection (OR = 0.96, 95% CI 0.67–1.37). RDP was associated with higher total (MD = 3009.31, 95% CI 1776.37–4242.24) and operative costs (MD = 3390.40, 95% CI 1981.79–4799.00). CONCLUSIONS: RDP was associated with a lower conversion rate, a higher spleen preservation rate and, in patients with PDAC, a higher lymph node yield and similar R0 resection rate, as compared to LDP. The potential benefits of RDP need to be weighed against the higher total and operative costs in future randomized trials. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-023-09894-y. Springer US 2023-02-13 2023 /pmc/articles/PMC10235152/ /pubmed/36781467 http://dx.doi.org/10.1007/s00464-023-09894-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review Article
van Ramshorst, Tess M. E.
van Bodegraven, Eduard A.
Zampedri, Pietro
Kasai, Meidai
Besselink, Marc G.
Abu Hilal, Mohammad
Robot-assisted versus laparoscopic distal pancreatectomy: a systematic review and meta-analysis including patient subgroups
title Robot-assisted versus laparoscopic distal pancreatectomy: a systematic review and meta-analysis including patient subgroups
title_full Robot-assisted versus laparoscopic distal pancreatectomy: a systematic review and meta-analysis including patient subgroups
title_fullStr Robot-assisted versus laparoscopic distal pancreatectomy: a systematic review and meta-analysis including patient subgroups
title_full_unstemmed Robot-assisted versus laparoscopic distal pancreatectomy: a systematic review and meta-analysis including patient subgroups
title_short Robot-assisted versus laparoscopic distal pancreatectomy: a systematic review and meta-analysis including patient subgroups
title_sort robot-assisted versus laparoscopic distal pancreatectomy: a systematic review and meta-analysis including patient subgroups
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10235152/
https://www.ncbi.nlm.nih.gov/pubmed/36781467
http://dx.doi.org/10.1007/s00464-023-09894-y
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