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<p>Robotic duodenopancreatectomy (RDP) has emerged as a transformative approach in pancreatic surgery, though its global adoption patterns and outcomes remain incompletely characterized. This systematic review and meta-analysis synthesizes data from 32 studies encompassing 3218 patients across North America, Europe, and Asia, representing the most comprehensive evaluation of RDP outcomes to date. Our analysis reveals a mean operative time of 356&#xa0;min (95% CI 328–384; I<sup>2</sup> = 89%), with significant regional variation—North American centers demonstrated 15% shorter operative durations compared to Asian institutions (321 vs 382&#xa0;min, p &lt; 0.01), consistent with findings from Stewart et al. (Surg Endosc 2019) regarding robotic surgery trends. The pooled conversion rate of 8.2% (95% CI 6.1–10.7) compares favorably to laparoscopic approaches as reported in the LEOPARD-2 trial (van Hilst et al., Lancet Gastroenterol Hepatol 2019), while major complication rates (18.5%, 95% CI 15.2–22.3) and 90-day mortality (3.1%, 95% CI 2.0–4.5) remain within acceptable ranges. Oncologically, RDP achieved an 84.6% R0 resection rate (95% CI 80.1–88.4), with European centers demonstrating superior outcomes (88.3%), likely reflecting the volume-outcome relationship described by Gooiker et al. (Br J Surg 2011). The learning curve analysis, building on Boone et al. (JAMA Surg 2015), shows high-volume centers (&gt; 20 cases/year) had significantly lower conversion rates (6.9% vs 11.3%, p = 0.03) and higher R0 margins (86.4% vs 80.2%, p = 0.02). These findings, analyzed using PRISMA-compliant methods with Egger's test confirming absence of publication bias (p = 0.21), position RDP as a viable alternative to open surgery when performed in experienced centers, though they underscore the need for standardized training protocols to address regional disparities.</p>

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Global trends in robotic duodenopancreatectomy for cancer: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年9月27日

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  • Danilo Coco,
  • Silvana Leanza

摘要

Robotic duodenopancreatectomy (RDP) has emerged as a transformative approach in pancreatic surgery, though its global adoption patterns and outcomes remain incompletely characterized. This systematic review and meta-analysis synthesizes data from 32 studies encompassing 3218 patients across North America, Europe, and Asia, representing the most comprehensive evaluation of RDP outcomes to date. Our analysis reveals a mean operative time of 356 min (95% CI 328–384; I2 = 89%), with significant regional variation—North American centers demonstrated 15% shorter operative durations compared to Asian institutions (321 vs 382 min, p < 0.01), consistent with findings from Stewart et al. (Surg Endosc 2019) regarding robotic surgery trends. The pooled conversion rate of 8.2% (95% CI 6.1–10.7) compares favorably to laparoscopic approaches as reported in the LEOPARD-2 trial (van Hilst et al., Lancet Gastroenterol Hepatol 2019), while major complication rates (18.5%, 95% CI 15.2–22.3) and 90-day mortality (3.1%, 95% CI 2.0–4.5) remain within acceptable ranges. Oncologically, RDP achieved an 84.6% R0 resection rate (95% CI 80.1–88.4), with European centers demonstrating superior outcomes (88.3%), likely reflecting the volume-outcome relationship described by Gooiker et al. (Br J Surg 2011). The learning curve analysis, building on Boone et al. (JAMA Surg 2015), shows high-volume centers (> 20 cases/year) had significantly lower conversion rates (6.9% vs 11.3%, p = 0.03) and higher R0 margins (86.4% vs 80.2%, p = 0.02). These findings, analyzed using PRISMA-compliant methods with Egger's test confirming absence of publication bias (p = 0.21), position RDP as a viable alternative to open surgery when performed in experienced centers, though they underscore the need for standardized training protocols to address regional disparities.