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Background <p>Portal-mesenteric vein resection (PMVR) is often necessary for pancreatic ductal adenocarcinoma (PDAC) with vascular invasion. While open pancreaticoduodenectomy (OPD) is the standard approach, robotic pancreaticoduodenectomy (RPD) offers a minimally invasive alternative with potential benefits but faces challenges related to technical complexity and safety. This meta-analysis compares perioperative outcomes of RPD with PMVR versus OPD with PMVR in PDAC. </p> Methods <p>A search of PubMed, Google Scholar, EMBASE, and the Cochrane Central Register of Controlled Trials identified observational studies published from January 2010 to September 2024. Studies included compared RPD and OPD with PMVR in PDAC, reporting 30-day mortality, major complications (Clavien-Dindo classification), and complications such as postoperative pancreatic fistulas (POPF), delayed gastric emptying (DGE), and post-pancreatectomy hemorrhage (PPH). Pooled estimates were calculated using a random-effects model. </p> Results <p>Four studies involving 288 patients met inclusion criteria (RPD + PMVR: n = 69; OPD + PMVR: n = 219). Thirty-day mortality (6.3% vs 5.6%, OR: 1.29, 95% CI 0.41–4.03, p = 0.66, I<sup>2</sup> = 0%), major complications (14.5% vs 21%, OR: 0.66, 95%CI 0.32–1.39, p = 0.27, I<sup>2</sup> = 0%), PPH (19% vs 8.9%, OR: 2.44, 95%CI 0.52–11.5, p = 0.26, I<sup>2</sup> = 45%), POPF (4.8% vs 7.04%, OR: 0.87, 95% CI 0.25–2.94, p = 0.82, I<sup>2</sup> = 0%), and DGE (23.8% vs 14.6%, OR: 1.81, 95% CI 0.88–3.72, p = 0.11, I<sup>2</sup> = 0%) were comparable between the RPD + PMVR and OPD + PMVR groups. However, RPD + PMVR was associated with a significantly shorter hospital length of stay (LOS) (mean difference: −4.76 days, 95% CI −&#xa0;7.85 to −&#xa0;1.67, p = 0.003, I<sup>2</sup> = 34%).</p> Conclusions <p>RPD + PMVR is comparable to OPD + PMVR in terms of safety and efficacy, with the added benefit of reduced hospital LOS.</p>

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Comparative 30-day mortality and complications in robotic vs. open pancreaticoduodenectomy with portal-mesenteric vein resection: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年8月7日

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  • Alejandro Mejia,
  • Elaina Vivian,
  • Jimmy Shah,
  • Juan Carlos Barrera Gutierrez

摘要

Background

Portal-mesenteric vein resection (PMVR) is often necessary for pancreatic ductal adenocarcinoma (PDAC) with vascular invasion. While open pancreaticoduodenectomy (OPD) is the standard approach, robotic pancreaticoduodenectomy (RPD) offers a minimally invasive alternative with potential benefits but faces challenges related to technical complexity and safety. This meta-analysis compares perioperative outcomes of RPD with PMVR versus OPD with PMVR in PDAC.

Methods

A search of PubMed, Google Scholar, EMBASE, and the Cochrane Central Register of Controlled Trials identified observational studies published from January 2010 to September 2024. Studies included compared RPD and OPD with PMVR in PDAC, reporting 30-day mortality, major complications (Clavien-Dindo classification), and complications such as postoperative pancreatic fistulas (POPF), delayed gastric emptying (DGE), and post-pancreatectomy hemorrhage (PPH). Pooled estimates were calculated using a random-effects model.

Results

Four studies involving 288 patients met inclusion criteria (RPD + PMVR: n = 69; OPD + PMVR: n = 219). Thirty-day mortality (6.3% vs 5.6%, OR: 1.29, 95% CI 0.41–4.03, p = 0.66, I2 = 0%), major complications (14.5% vs 21%, OR: 0.66, 95%CI 0.32–1.39, p = 0.27, I2 = 0%), PPH (19% vs 8.9%, OR: 2.44, 95%CI 0.52–11.5, p = 0.26, I2 = 45%), POPF (4.8% vs 7.04%, OR: 0.87, 95% CI 0.25–2.94, p = 0.82, I2 = 0%), and DGE (23.8% vs 14.6%, OR: 1.81, 95% CI 0.88–3.72, p = 0.11, I2 = 0%) were comparable between the RPD + PMVR and OPD + PMVR groups. However, RPD + PMVR was associated with a significantly shorter hospital length of stay (LOS) (mean difference: −4.76 days, 95% CI − 7.85 to − 1.67, p = 0.003, I2 = 34%).

Conclusions

RPD + PMVR is comparable to OPD + PMVR in terms of safety and efficacy, with the added benefit of reduced hospital LOS.