Does robotic pancreatoduodenectomy reduce the incidence of clinically relevant pancreatic fistula? A systematic review and meta-analysis #MMPMID41359172
Marchese T; Valle V; Spampinato MG; Depalma N; Libia A; Sergi W; Ielpo B
Surg Endosc 2025[Dec]; ? (?): ? PMID41359172show ga
BACKGROUND: Postoperative pancreatic fistula (POPF), particularly clinically relevant grades B and C (CR-POPF), remains a major source of morbidity following pancreatoduodenectomy (PD). Robotic pancreatoduodenectomy (RPD) has emerged as a minimally invasive alternative to open PD (OPD), potentially offering technical advantages that reduce complication rates. However, the true impact of RPD on CR-POPF remains unclear. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, including studies published between January 2010 and June 2025. PubMed, Embase, Scopus, and Web of Science were queried for randomized trials, cohort studies, and propensity score-matched (PSM) analyses comparing RPD and OPD concerning CR-POPF as defined by the International Study Group on Pancreatic Surgery (ISGPS). Study quality was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was graded using the GRADE framework. RESULTS: Thirty-two studies encompassing over 24 000 patients were included, of which approximately 5 000 underwent RPD and 19 600 underwent OPD. The pooled analysis showed a significantly lower incidence of CR-POPF in the RPD group (OR 0.60, 95% CI 0.51-0.67; p < 0.001), with moderate heterogeneity (I(2) = 56%). Subgroup analysis indicated that the benefit was limited to high-volume centers (>/= 20 RPD annually) and matched studies, while the two available randomized trials did not show a significant difference. CONCLUSIONS: RPD is associated with a reduced incidence of CR-POPF when performed in experienced, high-volume centers. These findings support the selective implementation of RPD within structured training and quality-control programs. Further high-quality randomized trials are needed to validate these results and explore long-term outcomes.
Surg+Endosc 2025 ; ? (?): ?
