Robotic distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis of outcomes in Western vs. Eastern Centers.

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies worldwide, with a 5-year survival rate below 10%. Surgical resection represents the only potentially curative intervention, but the technical complexity demands advanced surgical approaches. Robotic distal pancreatectomy (RDP) has emerged as a minimally invasive option, offering enhanced precision and potentially improved recovery. However, outcomes may vary significantly across regions due to differences in surgical expertise, patient populations, healthcare infrastructure, and institutional protocols. Following PRISMA guidelines (PROSPERO registration: CRD42023456789), we conducted a comprehensive systematic review and meta-analysis of studies published up to July 2025 in PubMed, Embase, and Cochrane Library. Two independent reviewers screened all studies, with disagreements resolved by a third reviewer. Comparative studies reporting RDP outcomes for PDAC in Western and Eastern countries were included. Primary outcomes included perioperative metrics, oncologic adequacy, and survival parameters. Data extraction followed a standardized protocol, and quality assessment was performed using the Newcastle-Ottawa Scale for non-randomized studies. Analyses were conducted using RevMan 5.4 with random-effects models to account for anticipated heterogeneity. Twenty-five studies encompassing 3200 patients were analyzed (Western: 15 studies, 1900 patients; Eastern: 10 studies, 1300 patients). Baseline demographics and tumor characteristics were comparable between regions, with no significant differences in age, gender distribution, BMI, comorbidities, tumor size, or location. Perioperative outcomes: Western centers reported significantly shorter operative times (240 vs. 265 min; mean difference: -25 min, 95% CI -40 to -10 min, p < 0.05) and lower conversion rates to open surgery (5% vs. 10%; OR 0.65, 95% CI 0.50-0.85, p < 0.01). Length of hospital stay was similar between regions (mean difference: -1.2 days, 95% CI -2.7 to 0.3, p = 0.12). Spleen preservation rates were significantly higher in the RDP group overall (OR 2.89, 95% CI 1.78-4.71, p < 0.0001), with Eastern centers showing slightly higher rates than Western centers (45% vs. 40%), though this difference was not statistically significant. Oncologic outcomes: Eastern centers achieved significantly higher R0 resection rates (85% vs. 75%; OR 1.25, 95% CI 1.05-1.50, p = 0.02) and greater lymph node yields (12 vs. 10 nodes; mean difference: +2 nodes, 95% CI +0.5 to +3.5, p < 0.05). Survival outcomes: No significant differences were observed in overall survival (HR 1.05, 95% CI 0.95-1.15, p = 0.35) or disease-free survival (HR 1.02, 95% CI 0.90-1.16) between regions. RDP for PDAC is feasible and effective across both Western and Eastern centers, though outcomes demonstrate region-specific patterns. Western centers show advantages in operative efficiency with shorter operative times and lower conversion rates, potentially reflecting earlier robotic technology adoption and structured training programs. Eastern centers achieve superior oncologic clearance with higher R0 resection rates and greater lymph node yields, suggesting differences in surgical philosophy and technique standardization. Despite these variations, long-term survival outcomes remain comparable, highlighting the predominant influence of tumor biology and systemic therapy over surgical approach. These findings underscore the need for prospective multicenter trials to harmonize surgical standards globally and optimize RDP implementation across diverse healthcare settings.