Robot-assisted versus laparoscopic distal pancreatectomy: an updated systematic review and meta-analysis including patient subgroups and meta-regression analyses

Clinical Snapshot

Key Findings

• P Value: Blood loss p < 0.00001; Conversions p < 0.00001; Splenectomy p < 0.0001

• Effect Size: Blood loss reduction: WMD -52.0 mL; Conversion rate: RR 0.49; Unplanned splenectomy: RR 0.59

• Primary Outcome: Comparable safety and oncologic outcomes between RDP and LDP

• Nnt Or Sensitivity: Conversion rate reduced by 51% with RDP; Unplanned splenectomy reduced by 41%

• Confidence Interval: Not specified in abstract but p-values provided

Clinical Application

Requires robotic surgical capability and appropriate training; selective use recommended for high-risk cases Relevant to major Australian hepatobiliary centres with robotic capabilities; cost considerations important given PBS funding constraints Patients requiring distal pancreatectomy, particularly those at high risk for conversion or complex resections

Abstract

Robot-assisted distal pancreatectomy (RDP) was developed to overcome technical limitations of laparoscopic distal pancreatectomy (LDP), yet uncertainty persists regarding oncologic adequacy, learning-curve effects, and outcomes in high-risk subgroups. We synthesized current evidence to address these gaps. We systematically searched PubMed and EMBASE, in accordance with PRISMA guidelines, from inception to 2025 to identify comparative studies of RDP versus LDP. Using random-effects models, we calculated weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, and performed subgroup analyses, including pancreatic ductal adenocarcinoma (PDAC), along with meta-regression to explore heterogeneity sources. Sixty-four studies comprising 15,790 patients (5,723 RDP; 10,067 LDP; mean age 60.5 years; BMI 26.1 kg/m²) were included. RDP resulted in lower blood loss (WMD - 52.0 mL; p < 0.00001), fewer conversions (RR 0.49; p < 0.00001), and fewer unplanned splenectomies (RR 0.59; p < 0.0001). Operative time was longer (WMD + 24.06 min; p < 0.00001). Postoperative morbidity, POPF, PPH, infection, reintervention, and mortality were comparable. Length of stay was shorter with RDP (WMD - 0.57 days; p < 0.00001). Although lymph node yield appeared higher with LDP in the overall and PDAC cohorts, this difference was no longer significant in a sensitivity analysis, and R0 resection rates remained comparable. Costs were higher with RDP, with substantial heterogeneity. RDP and LDP demonstrate comparable safety and oncologic outcomes. RDP reduces blood loss, conversions, and splenectomy but increases operative time and cost. The operative time disadvantage likely reflects learning-curve. Selective use in high-risk and complex resections is supported; cost-effectiveness warrants further study.

References

1. 1.Sabah, T., Ray, S., Patel, H., Baliga, P., Mah, H. K., Parekh, R., Sivashankari, T., Agnihotri, A., Ismail, A. H., & Salman, A. (2026). Robot-assisted versus laparoscopic distal pancreatectomy: an updated systematic review and meta-analysis including patient subgroups and meta-regression analyses. Journal of Robotic Surgery. https://doi.org/10.1007/s00464-025-11686-5