1. Outcomes of laparoscopic, robotic, and open pancreatoduodenectomy: A network meta-analysis of randomized controlled trials and propensity-score matched studies
- Author
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Eric Wu, Tousif Kabir, Brian K. P. Goh, Juinn Huar Kam, Hwee Leong Tan, and Nicholas Syn
- Subjects
medicine.medical_specialty ,Network Meta-Analysis ,Operative Time ,Blood Loss, Surgical ,Pancreaticoduodenectomy ,law.invention ,Postoperative Complications ,Robotic Surgical Procedures ,Blood loss ,Randomized controlled trial ,law ,medicine ,Humans ,Propensity Score ,Randomized Controlled Trials as Topic ,Surgical approach ,Gastric emptying ,business.industry ,Odds ratio ,Perioperative ,Length of Stay ,Surgery ,Meta-analysis ,Propensity score matching ,Laparoscopy ,business - Abstract
Background This network meta-analysis was performed to determine the optimal surgical approach for pancreatoduodenectomy by comparing outcomes after laparoscopic pancreatoduodenectomy, robotic pancreatoduodenectomy and open pancreatoduodenectomy. Methods A systematic search of the PubMed, EMBASE, Scopus, and Web of Science databases was conducted to identify eligible randomized controlled trials and propensity-score matched studies. Results Four randomized controlled trials and 23 propensity-score matched studies comprising a total of 4,945 patients were included for analysis. Operation time for open pancreatoduodenectomy was shorter than both laparoscopic pancreatoduodenectomy (mean difference –57.35, 95% CI 26.25–88.46 minutes) and robotic pancreatoduodenectomy (mean difference –91.08, 95% CI 48.61–133.56 minutes), blood loss for robotic pancreatoduodenectomy was significantly less than both laparoscopic pancreatoduodenectomy (mean difference –112.58, 95% CI 36.95–118.20 mL) and open pancreatoduodenectomy (mean difference –209.87, 95% CI 140.39–279.36 mL), both robotic pancreatoduodenectomy and laparoscopic pancreatoduodenectomy were associated with reduced rates of delayed gastric emptying compared with open pancreatoduodenectomy (odds ratio 0.59, 95% CI 0.39–0.90 and odds ratio 0.69, 95% CI 0.50–0.95, respectively), robotic pancreatoduodenectomy was associated with fewer wound infections compared with open pancreatoduodenectomy (odds ratio 0.35, 95% CI 0.18–0.71), and laparoscopic pancreatoduodenectomy patients enjoyed significantly shorter length of stay compared with open pancreatoduodenectomy (odds ratio 0.43, 95% CI 0.28–0.95). There were no differences in other outcomes. Conclusion This network meta-analysis of high-quality studies suggests that when laparoscopic pancreatoduodenectomy and robotic pancreatoduodenectomy are performed in high-volume centers, short-term perioperative and oncologic outcomes are largely comparable, if not slightly improved, compared with traditional open pancreatoduodenectomy. These findings should be corroborated in further prospective randomized studies.
- Published
- 2022