Cover Image

Non-inferiority of robotic versus open pancreatoduodenectomy: a systematic review and meta-analysis of prospective non-randomized and randomized trials

Background - With the recent publication of the first randomized controlled trials (RCTs) comparing robotic partial pancreatoduodenectomy (RPD) versus open partial pancreaticoduodenectomy (OPD) now providing high-level evidence, this study aims to analyze the short-term outcomes of RPD versus OPD to...

Full description

Saved in:
Bibliographic Details
Main Authors: Polychronidis, Georgios (Author) , Joos, Maximilian (Author) , Merz, Daniela (Author) , Holze, Magdalena (Author) , Kalkum, Eva (Author) , Probst, Pascal (Author) , Saeedi, Mohammed al (Author) , Michalski, Christoph (Author) , Loos, Martin (Author) , Hackert, Thilo (Author) , Klotz, Rosa (Author)
Format: Article (Journal)
Language:English
Published: February 2026
In: EClinicalMedicine
Year: 2026, Volume: 92, Pages: 1-13
ISSN:2589-5370
DOI:10.1016/j.eclinm.2026.103761
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.eclinm.2026.103761
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S2589537026000088
Get full text
Author Notes:Georgios Polychronidis, Maximilian C. Joos, Daniela C. Merz, Magdalena Holze, Eva Kalkum, Pascal Probst, Mohammed Al-Saeedi, Christoph W. Michalski, Martin Loos, Thilo Hackert, and Rosa Klotz
Description
Summary:Background - With the recent publication of the first randomized controlled trials (RCTs) comparing robotic partial pancreatoduodenectomy (RPD) versus open partial pancreaticoduodenectomy (OPD) now providing high-level evidence, this study aims to analyze the short-term outcomes of RPD versus OPD to answer the ongoing clinical debate regarding the advantages and limitations of RPD, particularly in terms of perioperative safety. - Methods - We searched Medline, Web of Science, and CENTRAL accessed last on 26th of November 2025 for prospective studies. The main outcome was 90-day mortality; secondary outcomes included complications, and short-term oncological outcomes (R0 resection rate), among others. A random-effects model was employed. Risk of bias was assessed using the Cochrane risk-of-bias-tool (RoB 2) for randomized controlled trials (RCTs), and the ROBINS-I-tool for comparative cohort trials (CCTs). The certainty of evidence was graded according to GRADE. (PROSPERO registration ID: CRD42024523577). - Findings - Out of a total of 7388 screened studies, 358 studies underwent full-text screening leading to inclusion of 7 studies (3 RCTs and 4 CCTs). No significant difference was observed between RPD and OPD for 90-day mortality [OR (95% CI) 1.07 (0.04, 29.40)], clinically relevant complications including postoperative pancreatic fistula (POPF), or reoperation rates [OR (95% CI) 1.10 (0.47, 2.59)]. Lymph node yield, R0 resection rate, operative time and length of hospital stay were also not significantly different. However, readmission rates favored OPD [OR (95% CI) 1.22 (1.15, 1.28)], while there was a lower amount of intraoperative blood loss in RPD [SMD (95% CI) −0.98 (−1.65, −0.32)]. - Interpretation - In this systematic review and meta-analysis, mortality following RPD was comparable to OPD. RPD has demonstrated similar rates for major complications and short-term oncological outcomes and can thus be equally recommended as OPD but this recommendation is limited to experienced, high-volume centers. - Funding - This systematic review and meta-analysis was investigator-initiated and did not receive additional funding.
Item Description:Gesehen am 15.04.2026
Physical Description:Online Resource
ISSN:2589-5370
DOI:10.1016/j.eclinm.2026.103761

Similar Items