这项系统评价和荟萃分析旨在比较机器人辅助手术与开腹手术治疗胰腺导管腺癌(PDAC)患者的围手术期和肿瘤学结果。该研究遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目。截至2024年6月15日的随机对照试验(RCT)和队列研究使用PubMed,EMBASE,谷歌学者。此外,纳入研究的参考清单,相关评论文章,和临床指南进行了手动搜索.评估的主要结果是住院时间,90天死亡率,术后胰瘘(POPF),和胰腺切除术后出血(PPH)。次要结果包括估计的失血量,再手术率,淋巴结产量,和手术时间。最终分析包括10项回顾性队列研究,涉及23,272例患者(2,179例机器人辅助手术和21,093例开放手术)。两种手术在术后胰瘘方面无显著差异,胰腺切除术后出血,淋巴结产量,和手术时间。然而,接受机器人辅助手术的患者住院时间较短,90天死亡率较低,与接受开放手术的人相比,估计的失血更少。机器人辅助组的再手术率较高。机器人辅助手术治疗胰腺导管腺癌是安全可行的。与开放手术相比,它提供了更好的围手术期和短期肿瘤学结果,但再次手术的风险更高。
This systematic review and meta-analysis aimed to compare perioperative and oncologic outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) treated with robotic-assisted surgery versus open laparotomy. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) and cohort studies up to June 15, 2024, were identified using PubMed, EMBASE, and Google Scholar. Additionally, reference lists of included studies, relevant review articles, and clinical guidelines were manually searched. The primary outcomes evaluated were length of stay, 90-day mortality, postoperative pancreatic fistula (POPF), and Post-pancreatectomy haemorrhage (PPH). Secondary outcomes included estimated blood loss, reoperation rate, lymph node yield, and operative time. The final analysis included 10 retrospective cohort studies involving 23,272 patients (2,179 robotic-assisted and 21,093 open surgery). There were no significant differences between the two procedures in terms of postoperative pancreatic fistula, Post-pancreatectomy haemorrhage, lymph node yield, and operative time. However, patients undergoing robotic-assisted surgery had shorter lengths of stay, lower 90-day mortality, and less estimated blood loss compared to those undergoing open surgery. The reoperation rate was higher for the robotic-assisted group. Robotic-assisted surgery for pancreatic ductal adenocarcinoma is safe and feasible. Compared to open surgery, it offers better perioperative and short-term oncologic outcomes, but with a higher risk of reoperation.