title: Systematic review and meta-analysis of robotic versus open pancreaticoduodenectomy.
abstract: Although robotic pancreaticoduodenectomy (RPD) has been successfully performed since 2003, its advantages over open pancreaticoduodenectomy (OPD) are still uncertain. The aim of this systematic review and meta-analysis was to compare the clinical outcomes of RPD to those of OPD.
  
  
  
  A systematic literature review was performed to identify RPD versus OPD comparative studies published between January 2003 and January 2016. Intraoperative outcomes, post-operative outcomes and oncologic safety were evaluated. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with a 95% confidence interval (95% CI) were calculated using fixed-effect or random-effect models.
  
  
  
  Nine non-randomized observational clinical studies involving 680 patients met the inclusion criteria and involved 245 RPDs and 435 OPDs. The overall complication rate was significantly lower in RPD (OR 0.65, 95% CI 0.47-0.91, P = 0.012), as well as the margin positivity rate (OR 0.40, 95% CI 0.20-0.77, P = 0.006), the wound infection rate (OR 0.18, 95% CI 0.06-0.53, P = 0.002) and the length of hospital stay (WMD = -6.00, 95% CI -9.80 to -2.21, P = 0.002). There was no significant difference in the following: the number of lymph nodes harvested; the operation time; the reoperation rate; the incidence of delayed gastric emptying, bile leakage, pancreatic fistula and clinically significant pancreatic fistula; and mortality. The mean conversion rate was 7.3% (range 0-14%).
  
  
  
  According to the results of this meta-analysis, RPD is as safe and efficient as OPD and is even favourable in terms of margin-negative resection, overall complication and wound infection rates and length of hospital stay. Given that there have not yet been any high-quality randomized controlled trials (RCTs), the evidence is still limited. Additional prospective, multi-centre RCTs are needed to further define the role of the robotic technique in PD.
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi Province, China.
authors.forename: Long
authors.initials: L
authors.lastname: Peng
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi Province, China.
authors.forename: Shengrong
authors.initials: S
authors.lastname: Lin
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi Province, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi Province, China. frankxwd@126.com.
authors.forename: Weidong
authors.initials: W
authors.lastname: Xiao
mesh_terms: D057868:Anastomotic Leak / Q000453:epidemiology; D018589:Gastroparesis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D000072662:Margins of Excision; D016017:Odds Ratio; D061646:Operative Time; D010185:Pancreatic Fistula / Q000453:epidemiology; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D065287:Robotic Surgical Procedures / Q000379:methods*
keywords: Complications; Oncologic safety; Open surgery; Pancreaticoduodenectomy; Robotic surgery