Short-term effectiveness of robotic <i>versus</i> laparoscopic distal pancreatectomy: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Xin ,  LEI Zehua , GAO Fengwei , JIANG Kangyi , XIE Qingyun , WU Jianping , FU Jinqiang , DU Bo , WANG Zhixu

Department of Hepatobilitary and Pancreaticosplenic Surgery, Leshan People’s Hospital of Sichuan Province, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

LEI Zehua, Email: leitsehua@126.com

Keywords：

robotics distal pancreatectomy; laparoscopic distal pancreatectomy; meta-analysis

DOI：

10.7507/1007-9424.201908047

Video：

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Objective To evaluate the short-term effectiveness of robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP) by meta-analysis.Methods We searched for manuscripts about RDP versus LDP form PubMed, The Cochrane Library, EMbase, CKNI, CBM, and WanFang Databases. The parallel quality assessment was selected according to the literature inclusion and exclusion criteria. Relevant data were extracted and meta-analysis was performed by using Revman 5.3 software.Results A total of 23 articles were included, and a total of3 487 patients enrolled who underwent pancreatic body resection. Meta-analysis results showed that compared with the LDP group, the RDP group had a longer operation time [MD=15.52, 95%CI was (0.60, 30.45), P=0.04], but the intraoperative blood loss was less [MD=–59.18, 95%CI was (–111.62, –6.73), P=0.03], the intraoperative spleen preservation rate was higher [OR=1.74, 95%CI was (1.02, 2.96), P=0.04], the intraoperative conversion to open rate was lower [ OR=0.45, 95%CI was (0.34, 0.60), P<0.000 01], and postoperative hospital stay was shorter [MD=–0.90, 95%CI was (–1.70, –0.10), P=0.03], while there were no significant differences in intraoperative blood transfusion rate [OR=0.88, 95%CI was (0.60, 1.30), P=0.52], incidence of postoperative overall complication [OR=0.88, 95%CI was (0.68, 1.13), P=0.32] and pancreatic leakage [OR=0.91, 95%CI was (0.72, 1.14), P=0.41], 90-day readmission rate [OR=1.32, 95%CI was (0.95, 1.83), P=0.10], and 90-day reoperation rate [OR=0.73, 95%CI was (0.40, 1.33), P=0.30].Conclusions RDP has the advantages of less bleeding, low turnover rate, and short postoperative hospital stay. However, due to the quality limitations of the included studies, the above conclusions still need to be verified by more high-quality studies.

Citation： ZHAO Xin, LEI Zehua, GAO Fengwei, JIANG Kangyi, XIE Qingyun, WU Jianping, FU Jinqiang, DU Bo, WANG Zhixu. Short-term effectiveness of robotic versus laparoscopic distal pancreatectomy: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(6): 718-728. doi: 10.7507/1007-9424.201908047 Copy

1.	Tax C, Govaert PHM, Stommel MWJ, et al. The value of decision analytical modeling in surgical research: an example of laparoscopic versus open distal pancreatectomy. Ann Surg, 2019, 269(3): 530-536.
2.	Stauffer JA, Coppola A, Mody K, et al. Laparoscopic versus open distal pancreatectomy for pancreatic adenocarcinoma. World J Surg, 2016, 40(6): 1477-1484.
3.	李中辉, 陈华, 陈宏泽, 等. 腹腔镜保留脾脏胰体尾切除术 17 例报道. 中国普外基础与临床杂志, 2018, 25(8): 929-933.
4.	彭承宏, 李花. 开腹还是腹腔镜或机器人: 胰体尾肿瘤切除方式的选择. 中华外科杂志, 2016, 54(11): 807-810.
5.	Di Benedetto F, Ballarin R, Magistri P. Robotic distal pancreatectomy: can results overcome cost-effectiveness prejudices? Hepatobiliary Surg Nutr, 2019, 8(3): 304-306.
6.	Caba Molina D, Lambreton F, Arrangoiz Majul R. Trends in robotic pancreaticoduodenectomy and distal pancreatectomy. J Laparoendosc Adv Surg Tech A, 2019, 29(2): 147-151.
7.	Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
8.	Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005, 5: 13.
9.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
10.	Waters JA, Canal DF, Wiebke EA, et al. Robotic distal pancreatectomy: cost effective? Surgery, 2010, 148(4): 814-823.
11.	Kang CM, Kim DH, Lee WJ, et al. Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc, 2011, 25(6): 2004-2009.
12.	Daouadi M, Zureikat AH, Zenati MS, et al. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg, 2013, 257(1): 128-132.
13.	Benizri EI, Germain A, Ayav A, et al. Short-term perioperative outcomes after robot-assisted and laparoscopic distal pancreatectomy. J Robot Surg, 2014, 8(2): 125-132.
14.	Duran H, Ielpo B, Caruso R, et al. Does robotic distal pancreatectomy surgery offer similar results as laparoscopic and open approach? A comparative study from a single medical center. Int J Med Robot, 2014, 10(3): 280-285.
15.	Adam MA, Choudhury K, Goffredo P, et al. Minimally invasive distal pancreatectomy for cancer: short-term oncologic outcomes in 1,733 patients. World J Surg, 2015, 39(10): 2564-2572.
16.	Butturini G, Damoli I, Crepaz L, et al. A prospective non-randomised single-center study comparing laparoscopic and robotic distal pancreatectomy. Surg Endosc, 2015, 29(11): 3163-3170.
17.	邓勇, 夏安宁, 张守响, 等. 达芬奇机器人与腹腔镜保脾胰体尾切除术近期临床疗效分析. 国际外科学杂志, 2015, 42(9): 596-599, 封3.
18.	Lee SY, Allen PJ, Sadot E, et al. Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. J Am Coll Surg, 2015, 220(1): 18-27.
19.	Ryan CE, Ross SB, Sukharamwala PB, et al. Distal pancreatectomy and splenectomy: a robotic or LESS approach. JSLS, 2015, 19(1): e2014.
20.	Lai EC, Tang CN. Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes. Front Med, 2015, 9(3): 356-360.
21.	Chen S, Zhan Q, Chen JZ, et al. Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study. Surg Endosc, 2015, 29(12): 3507-3518.
22.	尹注增, 许大彬, 谭向龙, 等. 机器人与腹腔镜保脾胰体尾切除术经济效益的对比. 腹腔镜外科杂志, 2016, 21(6): 429-432.
23.	Eckhardt S, Schicker C, Maurer E, et al. Robotic-assisted approach improves vessel preservation in spleen-preserving distal pancreatectomy. Dig Surg, 2016, 33(5): 406-413.
24.	Goh BK, Chan CY, Soh HL, et al. A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy. Int J Med Robot, 2017, 13(1): e1733.
25.	Morelli L, Guadagni S, Palmeri M, et al. A case-control comparison of surgical and functional outcomes of robotic-assisted spleen-preserving left side pancreatectomy versus pure laparoscopy. JOP, 2016, 17(1): 30-35.
26.	Xourafas D, Ashley SW, Clancy TE. Comparison of perioperative outcomes between open, laparoscopic, and robotic distal pancreatectomy: an analysis of 1 815 patients from the ACS-NSQIP Procedure-Targeted Pancreatectomy Database. J Gastrointest Surg, 2017, 21(9): 1442-1452.
27.	Ielpo B, Duran H, Diaz E, et al. Robotic versus laparoscopic distal pancreatectomy: a comparative study of clinical outcomes and costs analysis. Int J Surg, 2017, 48: 300-304.
28.	Zhang J, Jin J, Chen S, et al. Minimally invasive distal pancreatectomy for PNETs: laparoscopic or robotic approach? Oncotarget, 2017, 8(20): 33872-33883.
29.	Liu R, Liu Q, Zhao ZM, et al. Robotic versus laparoscopic distal pancreatectomy: a propensity score-matched study. J Surg Oncol, 2017, 116(4): 461-469.
30.	Raoof M, Nota CLMA, Melstrom LG, et al. Oncologic outcomes after robot-assisted versus laparoscopic distal pancreatectomy: analysis of the National Cancer Database. J Surg Oncol, 2018, 118(4): 651-656.
31.	Liu Q, Zhao ZM, Tan XL, et al. Short- and mid-term outcomes of robotic versus laparoscopic distal pancreatosplenectomy for pancreatic ductal adenocarcinoma: a retrospective propensity score-matched study. Int J Surg, 2018, 55: 81-86.
32.	林贤超, 黄鹤光, 陈燕昌, 等. 机器人和腹腔镜胰体尾切除术的回顾性队列研究. 中华外科杂志, 2019, 57(2): 102-107.
33.	Doncaster CP, Spake R. Correction for bias in meta-analysis of little-replicated studies. Methods Ecol Evol, 2017, 9(3): 634-644.
34.	Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
35.	Melvin WS, Needleman BJ, Krause KR, et al. Computer-enhanced robotic telesurgery. Initial experience in foregut surgery. Surg Endosc, 2002, 16(12): 1790-1792.
36.	张俊聪, 胡家平, 李太原, 等. 达芬奇机器人手术系统与腹腔镜胰十二指肠切除术近期疗效的 Meta 分析. 中华消化外科杂志, 2017, 16(8): 839-843.
37.	徐强, 吴文铭, 韩显林, 等. 机器人胰体尾切除术学习曲线分析(附 71 例报告). 中国实用外科杂志, 2018, 38(7): 801-805.

1. Tax C, Govaert PHM, Stommel MWJ, et al. The value of decision analytical modeling in surgical research: an example of laparoscopic versus open distal pancreatectomy. Ann Surg, 2019, 269(3): 530-536.
2. Stauffer JA, Coppola A, Mody K, et al. Laparoscopic versus open distal pancreatectomy for pancreatic adenocarcinoma. World J Surg, 2016, 40(6): 1477-1484.
3. 李中辉, 陈华, 陈宏泽, 等. 腹腔镜保留脾脏胰体尾切除术 17 例报道. 中国普外基础与临床杂志, 2018, 25(8): 929-933.
4. 彭承宏, 李花. 开腹还是腹腔镜或机器人: 胰体尾肿瘤切除方式的选择. 中华外科杂志, 2016, 54(11): 807-810.
5. Di Benedetto F, Ballarin R, Magistri P. Robotic distal pancreatectomy: can results overcome cost-effectiveness prejudices? Hepatobiliary Surg Nutr, 2019, 8(3): 304-306.
6. Caba Molina D, Lambreton F, Arrangoiz Majul R. Trends in robotic pancreaticoduodenectomy and distal pancreatectomy. J Laparoendosc Adv Surg Tech A, 2019, 29(2): 147-151.
7. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
8. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005, 5: 13.
9. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
10. Waters JA, Canal DF, Wiebke EA, et al. Robotic distal pancreatectomy: cost effective? Surgery, 2010, 148(4): 814-823.
11. Kang CM, Kim DH, Lee WJ, et al. Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc, 2011, 25(6): 2004-2009.
12. Daouadi M, Zureikat AH, Zenati MS, et al. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg, 2013, 257(1): 128-132.
13. Benizri EI, Germain A, Ayav A, et al. Short-term perioperative outcomes after robot-assisted and laparoscopic distal pancreatectomy. J Robot Surg, 2014, 8(2): 125-132.
14. Duran H, Ielpo B, Caruso R, et al. Does robotic distal pancreatectomy surgery offer similar results as laparoscopic and open approach? A comparative study from a single medical center. Int J Med Robot, 2014, 10(3): 280-285.
15. Adam MA, Choudhury K, Goffredo P, et al. Minimally invasive distal pancreatectomy for cancer: short-term oncologic outcomes in 1,733 patients. World J Surg, 2015, 39(10): 2564-2572.
16. Butturini G, Damoli I, Crepaz L, et al. A prospective non-randomised single-center study comparing laparoscopic and robotic distal pancreatectomy. Surg Endosc, 2015, 29(11): 3163-3170.
17. 邓勇, 夏安宁, 张守响, 等. 达芬奇机器人与腹腔镜保脾胰体尾切除术近期临床疗效分析. 国际外科学杂志, 2015, 42(9): 596-599, 封3.
18. Lee SY, Allen PJ, Sadot E, et al. Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. J Am Coll Surg, 2015, 220(1): 18-27.
19. Ryan CE, Ross SB, Sukharamwala PB, et al. Distal pancreatectomy and splenectomy: a robotic or LESS approach. JSLS, 2015, 19(1): e2014.
20. Lai EC, Tang CN. Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes. Front Med, 2015, 9(3): 356-360.
21. Chen S, Zhan Q, Chen JZ, et al. Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study. Surg Endosc, 2015, 29(12): 3507-3518.
22. 尹注增, 许大彬, 谭向龙, 等. 机器人与腹腔镜保脾胰体尾切除术经济效益的对比. 腹腔镜外科杂志, 2016, 21(6): 429-432.
23. Eckhardt S, Schicker C, Maurer E, et al. Robotic-assisted approach improves vessel preservation in spleen-preserving distal pancreatectomy. Dig Surg, 2016, 33(5): 406-413.
24. Goh BK, Chan CY, Soh HL, et al. A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy. Int J Med Robot, 2017, 13(1): e1733.
25. Morelli L, Guadagni S, Palmeri M, et al. A case-control comparison of surgical and functional outcomes of robotic-assisted spleen-preserving left side pancreatectomy versus pure laparoscopy. JOP, 2016, 17(1): 30-35.
26. Xourafas D, Ashley SW, Clancy TE. Comparison of perioperative outcomes between open, laparoscopic, and robotic distal pancreatectomy: an analysis of 1 815 patients from the ACS-NSQIP Procedure-Targeted Pancreatectomy Database. J Gastrointest Surg, 2017, 21(9): 1442-1452.
27. Ielpo B, Duran H, Diaz E, et al. Robotic versus laparoscopic distal pancreatectomy: a comparative study of clinical outcomes and costs analysis. Int J Surg, 2017, 48: 300-304.
28. Zhang J, Jin J, Chen S, et al. Minimally invasive distal pancreatectomy for PNETs: laparoscopic or robotic approach? Oncotarget, 2017, 8(20): 33872-33883.
29. Liu R, Liu Q, Zhao ZM, et al. Robotic versus laparoscopic distal pancreatectomy: a propensity score-matched study. J Surg Oncol, 2017, 116(4): 461-469.
30. Raoof M, Nota CLMA, Melstrom LG, et al. Oncologic outcomes after robot-assisted versus laparoscopic distal pancreatectomy: analysis of the National Cancer Database. J Surg Oncol, 2018, 118(4): 651-656.
31. Liu Q, Zhao ZM, Tan XL, et al. Short- and mid-term outcomes of robotic versus laparoscopic distal pancreatosplenectomy for pancreatic ductal adenocarcinoma: a retrospective propensity score-matched study. Int J Surg, 2018, 55: 81-86.
32. 林贤超, 黄鹤光, 陈燕昌, 等. 机器人和腹腔镜胰体尾切除术的回顾性队列研究. 中华外科杂志, 2019, 57(2): 102-107.
33. Doncaster CP, Spake R. Correction for bias in meta-analysis of little-replicated studies. Methods Ecol Evol, 2017, 9(3): 634-644.
34. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
35. Melvin WS, Needleman BJ, Krause KR, et al. Computer-enhanced robotic telesurgery. Initial experience in foregut surgery. Surg Endosc, 2002, 16(12): 1790-1792.
36. 张俊聪, 胡家平, 李太原, 等. 达芬奇机器人手术系统与腹腔镜胰十二指肠切除术近期疗效的 Meta 分析. 中华消化外科杂志, 2017, 16(8): 839-843.
37. 徐强, 吴文铭, 韩显林, 等. 机器人胰体尾切除术学习曲线分析(附 71 例报告). 中国实用外科杂志, 2018, 38(7): 801-805.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Short-term effectiveness of robotic versus laparoscopic distal pancreatectomy: a meta-analysis

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