To examine the feasibility and safety of robotic radical resection (RRR) for hilar cholangiocarcinoma (HCCA). A PRISMA-compliant meta-analysis with meta-regression was conducted, including studies reporting outcomes of RRR in patients with HCCA. Six studies comprising 295 patients were included. In highly selected patients (body mass index [BMI] < 25 kg/m” ; tumor size < 3 cm), RRR of HCCA proved safe and feasible (Clavien-Dindo ≥ III complications: 14.8% [95% confidence interval 8.7%–20.8%]; 30-day mortality:1.9% [0%–4.2%]; conversion to open surgery: 1.9% [0%–4.2%]; intraoperative blood loss: 210 mL [119–301 mL]; operative time: 481 minutes [339–623 minutes]; R0 resection rate: 82.2% [75.0%–89.4%]; retrieved lymph nodes: 12 [9–16]). Younger age (p = 0.008), higher BMI (p = 0.009), larger tumors (p = 0.048), and performing liver resections (p = 0.017) increased blood loss. American Society of Anesthesiologists status ≥ III (p < 0.001) and Bismuth IV disease (p < 0.001) increased operative times. Preoperative biliary drainage (p = 0.027) enhanced R0 resection rates. RRR led to less bleeding (mean difference [MD]: –184 mL, p = 0.0005), longer operative times (MD:162 minutes, p = 0.001), and improved R0 resection rates (odds ratio: 3.29, p = 0.006) compared with the open approach. Subject to selection bias and type 2 error, RRR for HCCA might be safe and feasible in highly selected patients (favorable BMI and tumor size). The findings should not be taken as definitive conclusions but may be used for hypothesis generation in subsequent trials.

To examine the feasibility and safety of robotic radical resection (RRR) for hilar cholangiocarcinoma (HCCA). A PRISMA-compliant meta-analysis with meta-regression was conducted, including studies reporting outcomes of RRR in patients with HCCA. Six studies comprising 295 patients were included. In highly selected patients (body mass index [BMI] < 25 kg/m” ; tumor size < 3 cm), RRR of HCCA proved safe and feasible (Clavien-Dindo ≥ III complications: 14.8% [95% confidence interval 8.7%–20.8%]; 30-day mortality:1.9% [0%–4.2%]; conversion to open surgery: 1.9% [0%–4.2%]; intraoperative blood loss: 210 mL [119–301 mL]; operative time: 481 minutes [339–623 minutes]; R0 resection rate: 82.2% [75.0%–89.4%]; retrieved lymph nodes: 12 [9–16]). Younger age (p = 0.008), higher BMI (p = 0.009), larger tumors (p = 0.048), and performing liver resections (p = 0.017) increased blood loss. American Society of Anesthesiologists status ≥ III (p < 0.001) and Bismuth IV disease (p < 0.001) increased operative times. Preoperative biliary drainage (p = 0.027) enhanced R0 resection rates. RRR led to less bleeding (mean difference [MD]: –184 mL, p = 0.0005), longer operative times (MD:162 minutes, p = 0.001), and improved R0 resection rates (odds ratio: 3.29, p = 0.006) compared with the open approach. Subject to selection bias and type 2 error, RRR for HCCA might be safe and feasible in highly selected patients (favorable BMI and tumor size). The findings should not be taken as definitive conclusions but may be used for hypothesis generation in subsequent trials.

To examine the feasibility and safety of robotic radical resection (RRR) for hilar cholangiocarcinoma (HCCA). A PRISMA-compliant meta-analysis with meta-regression was conducted, including studies reporting outcomes of RRR in patients with HCCA. Six studies comprising 295 patients were included. In highly selected patients (body mass index [BMI] < 25 kg/m” ; tumor size < 3 cm), RRR of HCCA proved safe and feasible (Clavien-Dindo ≥ III complications: 14.8% [95% confidence interval 8.7%–20.8%]; 30-day mortality:1.9% [0%–4.2%]; conversion to open surgery: 1.9% [0%–4.2%]; intraoperative blood loss: 210 mL [119–301 mL]; operative time: 481 minutes [339–623 minutes]; R0 resection rate: 82.2% [75.0%–89.4%]; retrieved lymph nodes: 12 [9–16]). Younger age (p = 0.008), higher BMI (p = 0.009), larger tumors (p = 0.048), and performing liver resections (p = 0.017) increased blood loss. American Society of Anesthesiologists status ≥ III (p < 0.001) and Bismuth IV disease (p < 0.001) increased operative times. Preoperative biliary drainage (p = 0.027) enhanced R0 resection rates. RRR led to less bleeding (mean difference [MD]: –184 mL, p = 0.0005), longer operative times (MD:162 minutes, p = 0.001), and improved R0 resection rates (odds ratio: 3.29, p = 0.006) compared with the open approach. Subject to selection bias and type 2 error, RRR for HCCA might be safe and feasible in highly selected patients (favorable BMI and tumor size). The findings should not be taken as definitive conclusions but may be used for hypothesis generation in subsequent trials.

BACKGROUND: The management of complex pattern of bleeding associated with pelvic trauma remains a big chalenge for trauma surgeons. We aimed to conduct a comprehensive meta-analysis to compare the outcomes of angioembolisation and pelvic packing in patients with pelvic trauma. METHODS: We conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. The primary outcome was defined as mortality. Combined overall effect sizes were calculated using random-effects models. Results are reported as the odds ratio (OR) and 95％ confidence interval (CI). RESULTS: We identified 3 observational studies reporting a total of 120 patients undergoing angioembolisation (n=60) or pelvic packing (n=60) for pelvic trauma. Reporting of the Injury Severity Score (ISS) was variable, with higher ISS in the pelvic packing group. The risk of bias was low in two studies, and moderate in one. The pooled analysis demonstrated that angioembolisation did not significantly reduce mortality in patients with pelvic trauma compared to surgery (OR=1.99; 95％CI= 0.83–4.78,P=0.12). There was mild between-study heterogeneity (I2=0％, P=0.65). CONCLUSION: Our analysis found no significant difference in mortality between angioembolisation and pelvic packing in patients with traumatic pelvic haemorrhage. The current level of evidence in this context is very limited and insufficient to support the superiority of a treatment modality. Future research is required.

Background: s/Aims: To determine short-term and long-term outcomes after pancreas preserving total duodenectomy (PPTD). Methods: A case series and a complementary meta-analysis were conducted. All patients with (pre)neoplastic lesions of duodenum who underwent PPTD in a tertiary center for pancreatic surgery between May 2009 and October 2022 were included for the case series.All studies in the literature with a sample size of 10 or more patients reporting outcomes of PPTD were included for the meta-analysis. Results: A total of 439 patients (18 from case series and 421 from literature) were analyzed. Clavien-Dindo (CD) I complications in 2.9% (95% confidence interval [CI] 0.6%–5.2%), CD II complications in 21.1% (14.6%–27.6%), CD III complications in 18.1% (9.3%–26.9%), CD IV complications in 2.7% (0.5%–4.9%), and CD V complications in 2.2% (0.2%–4.2%) of patients were found. Probabilities of overall survival and recurrence-free survival at 15 years were 87% and 86%, respectively. There was no significant difference in the risk of mortality (odds ratio [OR]: 0.82, p = 0.830), total complications (OR: 0.77, p = 0.440), postoperative pancreatic fistula (OR: 0.43, p = 0.140), delayed gastric emptying (OR: 0.70, p = 0.450), or postoperative bleeding (OR: 0.97, p = 0.960) between PPTD and pancreaticoduodenectomy. Conclusions PPTD is safe and feasible for (pre)neoplastic lesions of duodenum not involving the pancreatic head. The risk of severe complications (CD > III) is low and long-term outcomes are favorable. Whether PPTD provides advantages over more radical techniques in terms of long-term outcomes remains controversial and requires further research.

Background: s/Aims: To determine short-term and long-term outcomes after pancreas preserving total duodenectomy (PPTD). Methods: A case series and a complementary meta-analysis were conducted. All patients with (pre)neoplastic lesions of duodenum who underwent PPTD in a tertiary center for pancreatic surgery between May 2009 and October 2022 were included for the case series.All studies in the literature with a sample size of 10 or more patients reporting outcomes of PPTD were included for the meta-analysis. Results: A total of 439 patients (18 from case series and 421 from literature) were analyzed. Clavien-Dindo (CD) I complications in 2.9% (95% confidence interval [CI] 0.6%–5.2%), CD II complications in 21.1% (14.6%–27.6%), CD III complications in 18.1% (9.3%–26.9%), CD IV complications in 2.7% (0.5%–4.9%), and CD V complications in 2.2% (0.2%–4.2%) of patients were found. Probabilities of overall survival and recurrence-free survival at 15 years were 87% and 86%, respectively. There was no significant difference in the risk of mortality (odds ratio [OR]: 0.82, p = 0.830), total complications (OR: 0.77, p = 0.440), postoperative pancreatic fistula (OR: 0.43, p = 0.140), delayed gastric emptying (OR: 0.70, p = 0.450), or postoperative bleeding (OR: 0.97, p = 0.960) between PPTD and pancreaticoduodenectomy. Conclusions PPTD is safe and feasible for (pre)neoplastic lesions of duodenum not involving the pancreatic head. The risk of severe complications (CD > III) is low and long-term outcomes are favorable. Whether PPTD provides advantages over more radical techniques in terms of long-term outcomes remains controversial and requires further research.

Background: s/Aims: To determine short-term and long-term outcomes after pancreas preserving total duodenectomy (PPTD). Methods: A case series and a complementary meta-analysis were conducted. All patients with (pre)neoplastic lesions of duodenum who underwent PPTD in a tertiary center for pancreatic surgery between May 2009 and October 2022 were included for the case series.All studies in the literature with a sample size of 10 or more patients reporting outcomes of PPTD were included for the meta-analysis. Results: A total of 439 patients (18 from case series and 421 from literature) were analyzed. Clavien-Dindo (CD) I complications in 2.9% (95% confidence interval [CI] 0.6%–5.2%), CD II complications in 21.1% (14.6%–27.6%), CD III complications in 18.1% (9.3%–26.9%), CD IV complications in 2.7% (0.5%–4.9%), and CD V complications in 2.2% (0.2%–4.2%) of patients were found. Probabilities of overall survival and recurrence-free survival at 15 years were 87% and 86%, respectively. There was no significant difference in the risk of mortality (odds ratio [OR]: 0.82, p = 0.830), total complications (OR: 0.77, p = 0.440), postoperative pancreatic fistula (OR: 0.43, p = 0.140), delayed gastric emptying (OR: 0.70, p = 0.450), or postoperative bleeding (OR: 0.97, p = 0.960) between PPTD and pancreaticoduodenectomy. Conclusions PPTD is safe and feasible for (pre)neoplastic lesions of duodenum not involving the pancreatic head. The risk of severe complications (CD > III) is low and long-term outcomes are favorable. Whether PPTD provides advantages over more radical techniques in terms of long-term outcomes remains controversial and requires further research.

To compare the procedural outcomes of minimally invasive and open central pancreatectomy. A systematic review in compliance with PRISMA statement standards was conducted to identify and analyze studies comparing the procedural outcomes of minimally invasive (laparoscopic or robotic) central pancreatectomy with the open approach. Random effects modeling using intention to treat data, and individual patient as unit of analysis, was used for analyses. Seven comparative studies including 289 patients were included. The two groups were comparable in terms of baseline characteristics. The minimally invasive approach was associated with less intraoperative blood loss (mean difference [MD]: −153.13 mL, p = 0.0004); however, this did not translate into less need for blood transfusion (odds ratio [OR]: 0.30, p = 0.06). The minimally invasive approach resulted in less grade B−C postoperative pancreatic fistula (OR: 0.54, p = 0.03); this did not remain consistent through sensitivity analyses. There was no difference between the two approaches in operative time (MD: 60.17 minutes, p = 0.31), Clavien–Dindo ≥ 3 complications (OR: 1.11, p = 0.78), postoperative mortality (risk difference:−0.00, p = 0.81), and length of stay in hospital (MD: −3.77 days, p = 0.08). Minimally invasive central pancreatectomy may be as safe as the open approach; however, whether it confers advantage over the open approach remains the subject of debate. Type 2 error is a possibility, hence adequately powered studies are required for definite conclusions; future studies may use our data for power analysis.

To compare the procedural outcomes of minimally invasive and open central pancreatectomy. A systematic review in compliance with PRISMA statement standards was conducted to identify and analyze studies comparing the procedural outcomes of minimally invasive (laparoscopic or robotic) central pancreatectomy with the open approach. Random effects modeling using intention to treat data, and individual patient as unit of analysis, was used for analyses. Seven comparative studies including 289 patients were included. The two groups were comparable in terms of baseline characteristics. The minimally invasive approach was associated with less intraoperative blood loss (mean difference [MD]: −153.13 mL, p = 0.0004); however, this did not translate into less need for blood transfusion (odds ratio [OR]: 0.30, p = 0.06). The minimally invasive approach resulted in less grade B−C postoperative pancreatic fistula (OR: 0.54, p = 0.03); this did not remain consistent through sensitivity analyses. There was no difference between the two approaches in operative time (MD: 60.17 minutes, p = 0.31), Clavien–Dindo ≥ 3 complications (OR: 1.11, p = 0.78), postoperative mortality (risk difference:−0.00, p = 0.81), and length of stay in hospital (MD: −3.77 days, p = 0.08). Minimally invasive central pancreatectomy may be as safe as the open approach; however, whether it confers advantage over the open approach remains the subject of debate. Type 2 error is a possibility, hence adequately powered studies are required for definite conclusions; future studies may use our data for power analysis.

To compare the procedural outcomes of minimally invasive and open central pancreatectomy. A systematic review in compliance with PRISMA statement standards was conducted to identify and analyze studies comparing the procedural outcomes of minimally invasive (laparoscopic or robotic) central pancreatectomy with the open approach. Random effects modeling using intention to treat data, and individual patient as unit of analysis, was used for analyses. Seven comparative studies including 289 patients were included. The two groups were comparable in terms of baseline characteristics. The minimally invasive approach was associated with less intraoperative blood loss (mean difference [MD]: −153.13 mL, p = 0.0004); however, this did not translate into less need for blood transfusion (odds ratio [OR]: 0.30, p = 0.06). The minimally invasive approach resulted in less grade B−C postoperative pancreatic fistula (OR: 0.54, p = 0.03); this did not remain consistent through sensitivity analyses. There was no difference between the two approaches in operative time (MD: 60.17 minutes, p = 0.31), Clavien–Dindo ≥ 3 complications (OR: 1.11, p = 0.78), postoperative mortality (risk difference:−0.00, p = 0.81), and length of stay in hospital (MD: −3.77 days, p = 0.08). Minimally invasive central pancreatectomy may be as safe as the open approach; however, whether it confers advantage over the open approach remains the subject of debate. Type 2 error is a possibility, hence adequately powered studies are required for definite conclusions; future studies may use our data for power analysis.