Abstract:Background and Aims Surgical resection is still the preferred treatment for malignant pancreatic diseases at present. However, the use of robotic-assisted distal pancreatectomy (RDP) or laparoscopic distal pancreatectomy (LDP) is still controversial. This study was conducted to evaluate the efficacy and safety of using RDP and LDP in the treatment of patients with malignant pancreatic diseases by Meta-analysis, so as to obtain evidence-based information to provide basis for clinical decision-making.Methods The studies comparing the clinical efficacy of RDP versus LDP for malignant pancreatic diseases were collected by a computer-based search in several national and international databases from their inception to March 2021. After literature screening, data extraction and bias risk evaluation by two reviewers independently, Meta-analysis was performed using RevMan 5.4 software.Results Fifteen studies were finally included, involving 2 940 patients, of whom, 997 cases underwent RDP and 1 943 cases underwent LDP. The results of Meta-analysis showed that in RDP group compared with LDP group, the spleen preservation rate (OR=2.31, 95% CI=1.37-3.90, P=0.002) was increased, the intraoperative conversion rate (OR=0.36, 95% CI=0.24-0.52, P?0.000 01), 90-d reoperation rate (OR=0.46, 95% CI=0.24-0.89, P=0.02), and 30-d mortality (OR=0.18, 95% CI=0.06-0.53, P=0.002)were reduced, the operative time was prolonged (MD=-40.09, 95% CI=-77.64-2.54, P=0.04), and the number of lymph nodes harvested (MD=2.06, 95% CI=0.65-3.47, P=0.004) was increased. However, no significant differences were found in intraoperative blood loss, total complication rate, surgical site infection, pancreatic fistula, length of hospital stay, and 90-d readmission rate (all P>0.05).Conclusion The current evidence indicates that RDP may increase the spleen preservation rate and the number of lymph nodes harvested, and reduce open conversion rate, 90-d reoperation rate, and 30-d mortality compared with LDP. These results indicate that RDP and LDP have similar safety and efficacy in the treatment of malignant pancreatic diseases. Limited by the quality and quantity of the included studies, the above conclusions need to be verified by more multicenter randomized controlled trials with large sample size.