A Comprehensive Meta-Analysis Of Robotic Duodenopancreatectomy Versus Laparoscopic Duodenopancreatectomy For Adenocarcinoma Of The Head Of The Pancreas.

Background: The management of pancreatic ductal adenocarcinoma (PDAC), particularly in the head of the pancreas, has evolved with the advent of minimally invasive surgical techniques. Robotic duodenopancreatectomy (RPD) and laparoscopic duodenopancreatectomy (LPD) have emerged as two promising approaches. This meta-analysis aims to systematically compare the perioperative and long-term oncological outcomes of RPD versus LPD in patients undergoing surgery for pancreatic head adenocarcinoma. Methods: A systematic literature search was conducted across multiple databases, including PubMed, Embase, and Cochrane Library, to identify relevant studies published up to January 2025. The search was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data extraction focused on perioperative outcomes such as operative time, blood loss, complications, and length of hospital stay, as well as oncological outcomes like R0 resection rates and survival data. Statistical analyses were performed using random-effects models, and publication bias was assessed via Egger’s test. Results: A total of 12 studies encompassing 1,200 patients were included in the meta-analysis. RPD was associated with significant reductions in operative time (mean difference: -35 minutes; 95% CI: [-50, -20], p < 0.001), intraoperative blood loss (mean difference: -150 mL; 95% CI: [-200, -100], p < 0.001), and length of hospital stay (mean difference: -2 days; 95% CI: [-3, -1], p < 0.001) compared to LPD. No significant differences were observed in postoperative complication rates (RR: 0.95; 95% CI: [0.78, 1.15], p = 0.6), R0 resection rates (RR: 1.05; 95% CI: [0.93, 1.18], p = 0.45), or long-term survival outcomes. Conclusion: This meta-analysis suggests that RPD may offer certain perioperative advantages over LPD for the surgical management of pancreatic head adenocarcinoma, without compromising oncological outcomes. Further high-quality, multicenter randomized controlled trials are warranted to validate these findings.