Background: Distal pancreatectomy (DP) is a potentially curative procedure for tumors of the pancreatic body and tail. Minimally invasive DP (MIDP), including laparoscopic and robotic techniques, is increasingly being adopted. This study aimed to evaluate the perioperative outcomes of robotic DP (RDP) in comparison with laparoscopic and open approaches using a network meta-analysis and meta-regression. Methods: We systematically searched MEDLINE, EMBASE, Web of Science, and Scopus for studies comparing at least two surgical approaches. Both Bayesian and frequentist network meta-analyses were performed. Results: Sixty-seven studies involving 18,113 patients met the inclusion criteria. Surface under the cumulative ranking (SUCRA) analysis showed that RDP ranked first in 84.6% of measured parameters. Laparoscopic DP (LDP) demonstrated intermediate performance, whereas open DP (ODP) consistently ranked lowest. Operative time was significantly longer for RDP compared with ODP (MD = +25.93 min, 95% CI 7.68–44.18), while LDP and ODP were comparable. RDP significantly reduced 30-day mortality (OR = 0.37, 95% CI 0.16–0.84) and conversion rates compared with LDP (OR = 0.30, 95% CrI 0.22–0.40). Both minimally invasive approaches (RDP and LDP), compared with open surgery, were associated with reduced blood loss (−304 mL and −273 mL), fewer transfusions (OR 0.25 and 0.30), smaller transfused volumes (−1.98 and −1.86 units), shorter ICU stays (−4.0 and −2.3 days), fewer reinterventions (OR 0.45 and 0.56), and shorter hospital stays (−8.8 and −6.9 days), respectively. Conclusions: Although associated with longer operative time, RDP appears safe and may confer significant advantages over both laparoscopic and open surgery, including reduced 30-day mortality, lower conversion rates, and improved perioperative outcomes, particularly when performed in high-volume, well-equipped centers.
背景：远端胰腺切除术（DP）是治疗胰体尾部肿瘤的潜在根治性手术方式。微创远端胰腺切除术（MIDP），包括腹腔镜和机器人技术，正日益普及。本研究旨在通过网络荟萃分析和荟萃回归，评估机器人远端胰腺切除术（RDP）与腹腔镜及开腹手术的围手术期结局。方法：我们系统检索了MEDLINE、EMBASE、Web of Science和Scopus数据库中比较至少两种手术方式的研究。同时进行了贝叶斯和频率学派的网络荟萃分析。结果：共纳入67项研究，涉及18,113例患者。累积排序曲线下面积（SUCRA）分析显示，在84.6%的测量参数中，RDP排名第一。腹腔镜远端胰腺切除术（LDP）表现居中，而开腹远端胰腺切除术（ODP）始终排名最低。与ODP相比，RDP的手术时间显著延长（MD = +25.93分钟，95% CI 7.68–44.18），而LDP与ODP的手术时间相当。与LDP相比，RDP显著降低了30天死亡率（OR = 0.37, 95% CI 0.16–0.84）和中转开腹率（OR = 0.30, 95% CrI 0.22–0.40）。与开腹手术相比，两种微创手术方式（RDP和LDP）均与减少术中失血量（分别减少304 mL和273 mL）、降低输血率（OR分别为0.25和0.30）、减少输血量（分别减少1.98和1.86单位）、缩短ICU住院时间（分别减少4.0天和2.3天）、降低再干预率（OR分别为0.45和0.56）以及缩短总住院时间（分别减少8.8天和6.9天）相关。结论：尽管RDP手术时间较长，但其安全性良好，并且相较于腹腔镜和开腹手术可能具有显著优势，包括降低30天死亡率、减少中转开腹率以及改善围手术期结局，尤其是在高手术量、设备完善的医疗中心实施时。
肿瘤(癌症)患者之家