Evidence map›Paper›PMID 41631163›Full record

ArticleEClinicalMedicine2026

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

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 1 more

Abstract read
In one paragraph

Article in EClinicalMedicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Georgios PolychronidisDepartment of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Maximilian C JoosDepartment of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Daniela C MerzDepartment of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Magdalena HolzeDepartment of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Eva KalkumStudy Center of the German Society of Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany.
Pascal ProbstDepartment of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
Mohammed Al-SaeediDepartment of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Christoph W MichalskiDepartment of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Martin LoosDepartment of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Thilo HackertDepartment for General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Rosa KlotzDepartment of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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.

Indexed as

Meta-analysisOpen partial pancreaticoduodenectomyPancreatic cancerRobotic partial pancreaticoduodenectomySystematic review

Identifiers

PMID41631163
PMCPMC12860918

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.