OPEN VS ROBOTIC PANCREATECTOMY AS TREATMENT FOR PANCREATIC CANCER: ANALYSIS OF SURGICAL OUTCOMES AND ONCOLOGICAL SAFETY. SYSTEMATIC REVIEW
Keywords:
Pancreatectomy; Robotic surgery; Pancreatic neoplasms; Postoperative complications; Surgical margins; SurvivalAbstract
DOI: https://doi.org/10.46296/yc.v10i19.0959
Abstract
Background: Pancreatic cancer has high lethality, and curative-intent resection remains the central component of treatment for resectable disease. Robotic surgery aims to reduce perioperative injury without compromising oncological radicality. Objective: To compare perioperative outcomes, safety, and oncological outcomes of robotic versus open pancreatectomy in adults with pancreatic cancer. Methods: A systematic review was conducted according to PRISMA 2020. PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library were searched. Twelve articles providing direct comparisons or complementary evidence on robotic, open, or laparoscopic surgery were included. Risk of bias was assessed with RoB 2, ROBINS-I, and AMSTAR 2 as appropriate, and certainty by outcome was rated using GRADE. Because of heterogeneity, forest plots were considered exploratory. Results: A total of 1,134 records were identified, 1,042 were screened, and 12 articles were included. For robotic versus open distal pancreatectomy, hospital stay was reduced by 3.11 days (MD -3.11; 95% CI -4.45 to -1.77; I²=76%) and blood loss by 163.38 mL (MD -163.38; 95% CI -212.08 to -114.68; I²=87%). No significant differences were demonstrated in R0 resection (OR 1.27; 95% CI 0.62-2.60; I²=40%) or major complications (OR 1.27; 95% CI 0.88-1.81; I²=0%). Lymph-node yield, 90-day mortality, recurrence, and overall survival were comparable. Conclusions: Robotic pancreatectomy reduces hospital stay and blood loss without increasing major complications. Available oncological outcomes are comparable with open surgery. Certainty is moderate for perioperative outcomes and R0 resection, and low for mortality and survival.
Keywords: Pancreatectomy; Robotic surgery; Pancreatic neoplasms; Postoperative complications; Surgical margins; Survival.
Downloads
References
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. doi:10.3322/caac.21834.
Park W, Chawla A, O'Reilly EM. Pancreatic cancer: a review. JAMA. 2021;326(9):851-862. doi:10.1001/jama.2021.13027.
Mizrahi JD, Surana R, Valle JW, Shroff RT. Pancreatic cancer. Lancet. 2020;395(10242):2008-2020. doi:10.1016/S0140-6736(20)30974-0.
Kleeff J, Korc M, Apte M, La Vecchia C, Johnson CD, Biankin AV, et al. Pancreatic cancer. Nat Rev Dis Primers. 2016;2:16022. doi:10.1038/nrdp.2016.22.
Howard TJ, Krug JE, Yu J, Zyromski NJ, Schmidt CM, Jacobson LE, et al. A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon's contribution to long-term survival in pancreatic cancer. J Gastrointest Surg. 2006;10(10):1338-1345. doi:10.1016/j.gassur.2006.09.008.
Wang W, He Y, Wu L, Ye L, Yao Q, Tang Z, et al. Defining an adequate lymph node dissection criterion for pancreatic cancer. Ann Surg Oncol. 2022;29(3):1533-1539. doi:10.1245/s10434-021-10797-2.
Ielpo B, Caruso R, Duran H, Diaz E, Fabra I, Malave L, et al. Robotic versus standard open pancreatectomy: a propensity score-matched analysis. Updates Surg. 2019;71(1):137-144. doi:10.1007/s13304-018-0529-1.
Bencini L, Moraldi L, Miceli E, Risaliti M, Tofani L, Buccianti S, et al. Robotic versus open distal pancreatectomy: a propensity score-matched analysis. Int J Med Robot. 2024;20(6):e70025. doi:10.1002/rcs.70025.
Chen H, Wang Z, Huang X, Wang J, Dai Y, Wang K, et al. Robotic distal pancreatectomy reduces pancreatic fistula in patients without visceral obesity as compared to open distal pancreatectomy: a propensity score matching analysis. Int J Surg. 2021;90:105960. doi:10.1016/j.ijsu.2021.105960.
Magistri P, Boggi U, Esposito A, Carrano FM, Pesi B, Ballarin R, et al. Robotic versus open distal pancreatectomy: a multi-institutional matched comparison. J Hepatobiliary Pancreat Sci. 2021;28(12):1098-1106. doi:10.1002/jhbp.881.
Song Y, Chen S, Zhang T, Wang W, Qin R. Short- and long-term outcomes of robotic versus open radical antegrade modular pancreatosplenectomy for pancreatic ductal adenocarcinoma. Surg Endosc. 2024;38(3):1316-1328. doi:10.1007/s00464-023-10635-4.
Wang J, Liu Y, Wu Y. Comparison of perioperative outcomes of robotic vs open distal pancreatectomy: a meta-analysis of propensity-score-matched studies. Front Surg. 2025;12:1611773. doi:10.3389/fsurg.2025.1611773.
Zhou J, Xin C, Mou YP, Xu XW, Zhang MZ, Zhou YC, et al. Robotic versus open distal pancreatectomy: a meta-analysis. Medicine (Baltimore). 2020;99(23):e20435. doi:10.1097/MD.0000000000020435.
Gavriilidis P, Roberts KJ, Sutcliffe RP. Comparison of robotic, laparoscopic and open distal pancreatectomy: a network meta-analysis. HPB (Oxford). 2019;21(10):1268-1276. doi:10.1016/j.hpb.2019.04.010.
de Rooij T, van Hilst J, van Santvoort H, Boerma D, van den Boezem P, Daams F, et al. Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg. 2019;269(1):2-9. doi:10.1097/SLA.0000000000002979.
Korrel M, Jones LR, van Hilst J, Balzano G, Bjornsson B, Boggi U, et al. Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): an international randomized non-inferiority trial. Lancet Reg Health Eur. 2023;31:100673. doi:10.1016/j.lanepe.2023.100673.
Liu Q, Zhao Z, Zhang X, Tan X, Zhang T, Wang W, et al. Effect of robotic versus open pancreaticoduodenectomy on postoperative length of hospital stay: a randomized controlled trial. Lancet Gastroenterol Hepatol. 2024;9(5):428-437. doi:10.1016/S2468-1253(24)00005-0.
Klotz R, Mihaljevic AL, Kulu Y, Sander A, Klose C, Behnisch R, et al. Robotic versus open partial pancreatoduodenectomy (EUROPA): a randomized controlled stage 2b trial. Lancet Reg Health Eur. 2024;39:100864. doi:10.1016/j.lanepe.2024.100864.
Jin J, Chen J, Zhang H, Wang X, Li G, Liu R, et al. Robotic versus open pancreaticoduodenectomy for resectable pancreatic and periampullary tumours (PORTAL): multicentre randomized controlled non-inferiority trial. BMJ. 2026;394:e319692. doi:10.1136/bmj-2026-319692.
Menso JE, Bruna CL, Ali M, Bonsing B, Bosscha K, Brosens LAA, et al. Oncological outcome after robot-assisted versus open pancreatoduodenectomy for resectable pancreatic head cancer: a nationwide cohort analysis. Br J Surg. 2025;112(11):znaf153. doi:10.1093/bjs/znaf153.
Nassour I, Wang SC, Porembka MR, Yopp AC, Choti MA, Augustine MM, et al. Long-term oncologic outcomes of robotic and open pancreatectomy in a national cohort. J Surg Oncol. 2020;122(2):234-242. doi:10.1002/jso.25958.
Girgis MD, Zenati MS, King JC, Hamad A, Zureikat AH, Zeh HJ, et al. Oncologic outcomes after robotic pancreatic resections are not inferior to open surgery. Ann Surg. 2021;274(3):e262-e268. doi:10.1097/SLA.0000000000003615.
Nassour I, Winters SB, Hoehn R, Tohme S, Adam MA, Zureikat AH. Robotic versus open pancreatic resection after neoadjuvant therapy for pancreatic cancer. Surg Endosc. 2021;35(5):2248-2254. doi:10.1007/s00464-020-07638-w.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.
Sterne JAC, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. doi:10.1136/bmj.i4919.
Higgins JPT, Savovic J, Page MJ, Elbers RG, Sterne JAC. Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). London: Cochrane; 2023.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-926. doi:10.1136/bmj.39489.470347.AD.
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both. BMJ. 2017;358:j4008. doi:10.1136/bmj.j4008.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-560. doi:10.1136/bmj.327.7414.557.
Takagi K, Fuji T, Yasui K, Umeda Y, Yoshida R, Yamada M, et al. Outcomes after robot-assisted versus open pancreatoduodenectomy: a propensity score-matching analysis in a high-volume center (TAKUMI-7). Cancers (Basel). 2026;18(4):602. doi:10.3390/cancers18040602.
McKean J, Parrish A, Kahramangil Baytar D, Paniccia A, Hughes S, Nassour I. Oncologic efficacy of robotic compared to open total pancreatectomy for pancreatic cancer. J Surg Res. 2025;305:19-25. doi:10.1016/j.jss.2024.10.043.
Weng Y, Jiang Y, Fu N, Jin J, Shi Y, Huo Z, et al. Oncological outcomes of robotic versus open total pancreatectomy for pancreatic cancer. Hepatobiliary Surg Nutr. 2020;9(6):760-770. doi:10.21037/hbsn.2020.03.19.
Chaouch MA, Gouader A, Mazzotta A, Costa AC, Krimi B, Rahbari N, et al. Robotic versus open total pancreatectomy: a systematic review and meta-analysis. J Robot Surg. 2023;17(4):1259-1270. doi:10.1007/s11701-022-01564-9.
Huang JM, Chen SH, Chen TH. Short-term outcomes of conventional laparoscopic versus robot-assisted distal pancreatectomy for malignancy: evidence from US National Inpatient Sample, 2005-2018. Cancers (Basel). 2024;16(5):1003. doi:10.3390/cancers16051003.
Chen P, Zhou B, Wang T, Hu X, Ye Y, Guo W. Comparative effectiveness of robot-assisted versus laparoscopic distal pancreatectomy: a single-center study. J Healthc Eng. 2022;2022:7302222. doi:10.1155/2022/7302222.
Chen JW, van Ramshorst TME, Lof S, Abuawwad M, Al-Sarireh B, Armstrong T, et al. Robot-assisted versus laparoscopic distal pancreatectomy in resectable pancreatic cancer: an international retrospective cohort study. Ann Surg Oncol. 2023;30(5):3023-3032. doi:10.1245/s10434-022-13054-2.
Di Franco G, Peri A, Lorenzoni V, Palmeri M, Furbetta N, Guadagni S, et al. Minimally invasive distal pancreatectomy: cost analysis of matched cases comparing robotic and laparoscopic surgery. Surg Endosc. 2022;36(1):651-662. doi:10.1007/s00464-021-08332-1.
Lof S, van der Heijde N, Abuawwad M, Al-Sarireh B, Boggi U, Butturini G, et al. Robotic versus laparoscopic distal pancreatectomy: a multicenter analysis. Br J Surg. 2021;108(2):188-195. doi:10.1093/bjs/znaa118.
Jiang Y, Zheng K, Zhang S, Wang X, Chen S, Chen J, et al. Robotic distal pancreatectomy improves spleen preservation compared with laparoscopic distal pancreatectomy for benign and low-grade malignant pancreatic lesions. HPB (Oxford). 2022;24(2):241-249. doi:10.1016/j.hpb.2021.10.003.
Souche R, Herrero A, Bourel G, Chauvat J, Pirlet I, Guillon F, et al. Robotic versus laparoscopic distal pancreatectomy: a prospective French single-center experience and cost-effectiveness analysis. Surg Endosc. 2019;33(11):3562-3569. doi:10.1007/s00464-018-6080-9.
van Ramshorst TME, Boggi U, Armstrong T, Butturini G, de Hingh IHJT, de Pastena M, et al. Robot-assisted versus laparoscopic distal pancreatectomy: a systematic review and meta-analysis. Surg Endosc. 2023;37(6):4131-4143. doi:10.1007/s00464-023-09894-y.
Rompianesi G, Montalti R, Troisi RI. Robotic versus laparoscopic spleen-preserving distal pancreatectomy: a systematic review and meta-analysis. J Pers Med. 2021;11(6):552. doi:10.3390/jpm11060552.
Weng Y, Jiang Y, Fu N, Jin J, Shi Y, Huo Z, et al. Robotic-assisted versus open distal pancreatectomy for benign and low-grade malignant tumors: a propensity score-matched study. Surg Endosc. 2021;35(5):2255-2264. doi:10.1007/s00464-020-07639-9.
Kamarajah SK, Bundred J, Marc OS, Jiao LR, Hilal MA, White SA, et al. A national population-based cohort study of open, laparoscopic and robotic distal pancreatectomy in the United Kingdom. J Minim Access Surg. 2022;18(1):77-83. doi:10.4103/jmas.JMAS_163_20.
Luo YC, Yang TY, Li W, Yu QJ, Xia X, Lin ZY, et al. Perioperative and oncologic outcomes of robot-assisted versus open surgery for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. J Robot Surg. 2024;18(1):288. doi:10.1007/s11701-024-02054-3.
Wong NZH, Yap DWT, Ng SL, Ng JYN, James JJ, Kow AWC. Oncological outcomes in minimally invasive vs open distal pancreatectomy: a systematic review and network meta-analysis. Front Surg. 2024;11:1369169. doi:10.3389/fsurg.2024.1369169.
Neshan M, Padmanaban V, Chick RC, Pawlik TM. Open vs robotic-assisted pancreaticoduodenectomy: cost-effectiveness and long-term oncologic outcomes. J Gastrointest Surg. 2024;28(11):1933-1942. doi:10.1007/s11605-024-05941-3.
De Pastena M, Esposito A, Paiella S, Surci N, Montagnini G, Marchegiani G, et al. Cost-effectiveness and quality of life analysis of laparoscopic and robotic distal pancreatectomy. Surg Endosc. 2021;35(3):1420-1428. doi:10.1007/s00464-020-07528-1.
Koh YX, Tan HJ, Lee SY, Cheow PC, Chung AYF, Ooi LLPJ, et al. Economic efficiency of open, laparoscopic and robotic distal pancreatectomy: a network meta-analysis. Surg Endosc. 2024;38(6):3035-3051. doi:10.1007/s00464-024-10889-6.
Klompmaker S, van Hilst J, Wellner UF, Busch OR, Coratti A, D'Hondt M, et al. Outcomes after a learning curve of robotic distal pancreatectomy: procedure-specific training can reduce learning time. Ann Surg. 2021;274(1):e18-e27. doi:10.1097/SLA.0000000000003291.
Nickel F, Haney CM, Kowalewski KF, Probst P, Limen EF, Kalkum E, et al. Initial learning curves for robotic and laparoscopic pancreatic surgery. Br J Surg. 2023;110(9):1063-1067. doi:10.1093/bjs/znad045.
Lof S, van Hilst J, Abuawwad M, Al-Sarireh B, Boggi U, Butturini G, et al. Learning curves of minimally invasive distal pancreatectomy in experienced pancreatic centers. JAMA Surg. 2023;158(9):927-933. doi:10.1001/jamasurg.2023.2279.
Cucchetti A, Ricci C, Casadei R, Taffurelli G, Pacilio CA, Minni F. Advantages of minimally invasive distal pancreatectomy beyond length of stay. Surgery. 2023;173(4):1023-1029. doi:10.1016/j.surg.2022.11.029.
De Pastena M, Paiella S, Esposito A, Secchettin E, De Marchi G, Montagnini G, et al. Clinical and economic impact of surgical site infection after distal pancreatectomy. Surgery. 2022;171(6):1652-1657. doi:10.1016/j.surg.2021.11.010.
van Bodegraven EA, Mungroop TH, van Rijssen LB, van Hilst J, Bosscha K, Busch OR, et al. Hospital costs of complications after distal pancreatectomy. HPB (Oxford). 2023;25(10):1145-1150. doi:10.1016/j.hpb.2023.03.007.
Weinberg L, Wong D, Karalapillai D, Pearce B, Tan CO, Tay S, et al. The impact of complications on health care costs after distal pancreatectomy. Front Surg. 2022;9:890518. doi:10.3389/fsurg.2022.890518.
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group definition and grading of postoperative pancreatic fistula. Surgery. 2017;161(3):584-591. doi:10.1016/j.surg.2016.11.014.
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery. Surgery. 2007;142(5):761-768. doi:10.1016/j.surg.2007.05.005.
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage: an International Study Group of Pancreatic Surgery definition. Surgery. 2007;142(1):20-25. doi:10.1016/j.surg.2007.02.001.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. doi:10.1097/01.SLA.0000133083.54934.AE.
Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85(1):109-117. doi:10.1093/bja/85.1.109.
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78(5):606-617. doi:10.1093/bja/78.5.606.
Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3):292-298. doi:10.1001/jamasurg.2016.4952.
Vamvakas EC, Blajchman MA. Transfusion-related immunomodulation (TRIM): an update. Blood Rev. 2007;21(6):327-348. doi:10.1016/j.blre.2007.07.003.
Bailey P, Chang DK, Nones K, Johns AL, Patch AM, Gingras MC, et al. Genomic analyses identify molecular subtypes of pancreatic cancer. Nature. 2016;531(7592):47-52. doi:10.1038/nature16965.
Waddell N, Pajic M, Patch AM, Chang DK, Kassahn KS, Bailey P, et al. Whole genomes redefine the mutational landscape of pancreatic cancer. Nature. 2015;518(7540):495-501. doi:10.1038/nature14169.
Rhim AD, Mirek ET, Aiello NM, Maitra A, Bailey JM, McAllister F, et al. EMT and dissemination precede pancreatic tumor formation. Cell. 2012;148(1-2):349-361. doi:10.1016/j.cell.2011.11.025.
Published
How to Cite
License
Copyright (c) 2026 REVISTA CIENTÍFICA MULTIDISCIPLINARIA ARBITRADA YACHASUN - ISSN: 2697-3456
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
