Robotic pancreaticoduodenectomy provides better histopathological outcomes as compared to its open counterpart: a meta-analysis

The aim of this meta-analysis was to evaluate whether robotic pancreaticoduodenectomy (PD) may provide better clinical and pathologic outcomes compared to its open counterpart. The Pubmed, EMBASE, and Cochrane Library were systematically searched. Overall postoperative morbidity and resection margin involvement rate were the primary endpoints. Secondary endpoints included operating time, estimated blood loss (EBL), incisional surgical site infection (SSI) rate, length of hospital stay (LOS), and number of lymph nodes harvested. Twenty-four studies totaling 12,579 patients (2,175 robotic PD and 10,404 open PD were included. Overall postoperative mortality did not significantly differ OR (95%CI) = 0.86 (0.74, 1.01); p = 0.06. Resection margin involvement rate was significantly lower in robotic PD 15.6% vs. 19.9%; OR (95%CI) = 0.64 (0.41, 1.00); p = 0.05; NNT = 23. Operating time was significantly longer in robotic PD MD (95%CI) = 75.17 (48.05, 102.28); p < 0.00001. EBL was significantly decreased in robotic PD MD (95%CI) = - 191.35 (- 238.12, - 144.59); p < 0.00001. Number of lymph nodes harvested was significantly higher in robotic PD MD (95%CI) = 2.88 (1.12, 4.65); p = 0.001. This meta-analysis found that robotic PD provides better histopathological outcomes as compared to open PD at the cost of longer operating time. Furthermore, robotic PD did not have any detrimental impact on clinical outcomes, with lower wound infection rates.