Duodenopancreatectomía cefálica robótica versus abierta. Revisión sistemática

Abstract

Background: The present study aims to compare the clinical outcomes of robotic versus open pancreaticoduodenectomy. Methodology: A systematic literature review was performed to identify all studies evaluating the outcomes of robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) published from 2003 to 2023. Intraoperative and postoperative outcomes, as well as morbidity and mortality, were evaluated. Meta-analysis was performed. Results: Twenty non-randomized observational comparative studies involving 27,247 patients met the inclusion and exclusion criteria, with 3,672 RPD and 27,247 OPD. The RPD was associated with lower blood loss (WMD -167.81, 95% CI -2.63,-98.83, p= <0.00001), transfusion (OR 0.52, 95% CI 0.34 - 0.79, p= 0.002), vascular resection (OR 0.58, 95% CI 0.42 - 0.80, p= 0.001), hospital stay (WMD -2.19, 95% CI -3.68, -0.69, p= 0.004), postoperative pancreatic fistula (OR 0.81, 95% CI 0.69 - 0.94, p= 0.006), operative site infection (OR 0.26, 95% CI 0.17 - 0.41, p=<0.00001), mortality (OR 0.72, 95% CI 0.57 - 0.91, p= 0.006), and 90-day mortality (OR 0.72, 95% CI 0.55 - 0.93, p= 0.01) compared to OPD. There were no statistically significant differences in lymph node dissection, R0 resection, abdominal abscess, biliary fistula, delayed gastric emptying, postoperative bleeding, reoperations, morbidity, and 30-day mortality. Conclusions: RPD is safe and favorable in terms of mortality compared to open surgery. However, randomized control trials with high methodological quality are needed.