Comparison of outcomes of laparoscopic vs. robotic surgical resection of pancreatic neuroendocrine tumors: a systematic review and meta-analysis.

Introduction: Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms. Minimal access surgery has been the favoured approach for these tumors over the past decade. There is a lack of robust data comparing laparoscopic and robotic pancreatic surgery for PNETs and this has led to the lack of a global conclusion regarding which approach is superior. Thus, we conducted a systematic review and meta-analysis of the available data to compare outcomes following laparoscopic versus robotic pancreatic surgery for pancreatic neuroendocrine tumors.

Methods: Studies reporting outcomes of laparoscopic or robotic surgery for pancreatic neuroendocrine tumors were included. Inverse variance and Mantel-Haenszel statistical analysis methods were used for continuous and dichotomous data, respectively. All outcomes were quantitatively analyzed using the random effects model. The risk of bias was assessed using the ROBINS-1 tool.

Results: A total of 14 studies with 767 patients were included. The mean difference in the operating time was 21.08 min (95% CI: -4.38, 46.54, I² = 43%), favouring the laparoscopic group. The pooled odds ratio for the rate of formation of the pancreatic fistula was 0.88 (95% CI: 0.54, 1.45, I² = 0%), favouring the robotic group. Blood loss was higher in the laparoscopic group (MD = -89.72 ml, 95% CI:-143.37 to -36.06, I² = 93%). Other parameters, including re-exploration rate, length of hospital stay, R0 resection, rate of conversion, and spleen preservation, were similar in both groups.

Conclusion: The robotic approach might be preferable to the laparoscopic approach because of the lower rate of POPF and blood loss. Larger randomised controlled trials are required to ascertain these findings.