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Background <p>Minimally invasive pancreatoduodenectomy has seen growing implementation owing to its potential benefits in postoperative recovery; however, the impact of robotic pancreatoduodenectomy (RPD) compared with laparoscopic pancreatoduodenectomy (LPD) on postoperative pancreatic fistula (POPF), the most significant source of morbidity, remains unclear. Determining whether the robotic approach reduces POPF incidence is critical for surgical decision-making.</p> Methods <p>A&#xa0;systematic review was conducted of studies published up to 2025 that compared RPD and LPD in patients with pancreatic head or periampullary malignancies. In total, 12&#xa0;studies were included, encompassing multicenter propensity-matched cohorts, single-center series, and retrospective analyses. Primary outcomes were overall and clinically relevant POPF. Secondary outcomes included operative time, blood loss/transfusion, conversion, delayed gastric emptying, length of stay, lymph node yield, resection margins, and mortality. Study quality was assessed using MINORS and ROBINS‑I tools.</p> Results <p>Overall and grade&#xa0;B/C POPF rates were similar between robotic and laparoscopic approaches, with no consistent advantage for either technique. Secondary outcomes showed greater variability. Whereas RPD was associated with lower blood loss, reduced conversion rates, and shorter length of stay, operative time was longer for robotic procedures. Oncologic outcomes were equivalent between groups. The quality of evidence was limited by retrospective design, heterogeneity of definitions, and moderate-to-serious risk of bias.</p> Conclusion <p>Both RPD and LPD yield comparable perioperative and oncologic outcomes in experienced centers, although isolated technical advantages were observed for each approach. The heterogeneous and predominantly retrospective nature of the evidence highlights the need for prospective, randomized comparative studies to better define the optimal role of each modality.</p>

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Robotic versus laparoscopic pancreatoduodenectomy for pancreatic head and periampullary tumors: a systematic review focused on postoperative pancreatic fistula

  • 期刊论文

  • 发表日期：

    2026年6月17日

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  • Lazaros Kourtidis,
  • Panagis M. Lykoudis,
  • Christos Iordanou,
  • Leonidas Brilakis,
  • Apostolos Zatagias,
  • Georgios D. Ayiomamitis,
  • Dimitrios Patsouras,
  • Dimitrios Dimitroulis

摘要

Background

Minimally invasive pancreatoduodenectomy has seen growing implementation owing to its potential benefits in postoperative recovery; however, the impact of robotic pancreatoduodenectomy (RPD) compared with laparoscopic pancreatoduodenectomy (LPD) on postoperative pancreatic fistula (POPF), the most significant source of morbidity, remains unclear. Determining whether the robotic approach reduces POPF incidence is critical for surgical decision-making.

Methods

A systematic review was conducted of studies published up to 2025 that compared RPD and LPD in patients with pancreatic head or periampullary malignancies. In total, 12 studies were included, encompassing multicenter propensity-matched cohorts, single-center series, and retrospective analyses. Primary outcomes were overall and clinically relevant POPF. Secondary outcomes included operative time, blood loss/transfusion, conversion, delayed gastric emptying, length of stay, lymph node yield, resection margins, and mortality. Study quality was assessed using MINORS and ROBINS‑I tools.

Results

Overall and grade B/C POPF rates were similar between robotic and laparoscopic approaches, with no consistent advantage for either technique. Secondary outcomes showed greater variability. Whereas RPD was associated with lower blood loss, reduced conversion rates, and shorter length of stay, operative time was longer for robotic procedures. Oncologic outcomes were equivalent between groups. The quality of evidence was limited by retrospective design, heterogeneity of definitions, and moderate-to-serious risk of bias.

Conclusion

Both RPD and LPD yield comparable perioperative and oncologic outcomes in experienced centers, although isolated technical advantages were observed for each approach. The heterogeneous and predominantly retrospective nature of the evidence highlights the need for prospective, randomized comparative studies to better define the optimal role of each modality.