Comparison Of Surgical Outcomes Of Robot-assisted Laparoscopic Distal Pancreatectomy Versus Laparoscopic:A Systematic Review

Objective To evaluate surgical outcomes of Da Vinci robotic and laparoscopic for distal pancreatectomy by performing a systematic review of the published studies.Methods A systematic search was performed in the Cochrane Library,PubMed,EMBASE,Web of Science,CNKI,VIP and Wanfang Database up to December 2016 for studies that compared the surgical outcomes of RADP vs.LDP for pancreatic resections.The weighted mean differences(WMDs),odds ratios(ORs)and 95% confidence intervals(CIs)were calculated,and the data were combined using the random-effects model.The Grades of Recommendation,Assessment,Development,and Evaluation Working Group(GRADE)system was used to interpret the primary outcomes of this meta-analysis.Research Indicators was operative time(OT),mean estimated blood loss(EBL),and spleen-preservation(SP)rate.The following five primary postoperative outcomes were analysed: hospital length of stay(LOS),total complications(TCs),severe complications(SCs),total pancreatic fistulas(TPFs),and severe pancreatic fistulas(SPFs).All calculations and statistical tests were performed using Stata12.0 software.Results A total of fifteen non-randomized observational clinical studies involving 1,379 patients satisfied the eligibility criteria,including 970 LDP and 409 RADP.Compared with LDP,RADP was associated with a longer operative time(WMD = 37.27,P = 0.018),a shorter hospital length of stay(WMD =-1.33,P = 0.030),and a higher rate of spleen preservation(OR = 2.16,P = 0.022).Moreover,RADP was associated with a shorter hospital LOS(WMD =-4.66,P = 0.014)and a lower total complication rate(OR = 0.55,P = 0.034)than ODP.We found no statistically significant differences between the techniques in the mean estimated blood loss(P = 0.792;P = 0.212),severe complication rate(P = 0.366;P = 0.853),incidence of total pancreatic fistulas(P = 0.962;P = 0.168)or incidence of severe pancreatic fistulas(P = 0.309;P = 0.130).The overall quality of evidence was poor for all outcomes.Conclusions Robot-assisted distal pancreatectomy(RADP)has been developed with the aim of improving surgical quality and overcoming the limitations of laparoscopic distal pancreatectomy(LDP)for pancreatic resections.This meta-analysis indicates that RADP may be a technically safe and feasible alternative for distal pancreatectomy compared with laparoscopic resections.