Is total laparoscopic pancreaticoduodenectomy superior to open procedure? A meta-analysis

Table 4 Results of sensitivity analysis of total laparoscopic pancreaticoduodenectomy vs open pancreaticoduodenectomy

Outcomes of interest	No. of Studies	Sample size		Heterogeneity		Model	Overall effect size	95%CI of overall effect	P-value
		TLPD	OPD	P	I2
Operative time	10	577	1064	< 0.00001	98%	R	WMD = 74.66	43.71, 105.62	< 0.00001
EBL	9	547	1034	< 0.00001	95%	R	WMD = -280.46	-347.73, -213.19	< 0.00001
Transfusion rate	10	573	1071	0.15	32%	F	OR = 0.45	0.35, 0.58	< 0.00001
Overall morbidity	9	381	607	0.31	15%	F	OR = 0.88	0.65, 1.18	0.38
Major morbidity	15	829	1414	0.49	0	F	OR = 0.75	0.59, 0.96	0.02
POPF	15	617	1003	0.61	0	F	OR = 0.82	0.64, 1.05	0.11
POPF (grade B/C)	17	877	1531	0.89	0	F	OR = 0.86	0.66, 1.11	0.24
DGE	10	523	801	0.93	0	F	OR = 0.93	0.64, 1.34	0.69
DGE (grade B/C)	7	479	994	0.60	0	F	OR = 0.63	0.45, 0.88	0.006
PPH	11	434	737	0.84	0	F	OR = 1.48	0.93, 2.36	0.10
PPH (grade B/C)	7	454	966	0.91	0	F	OR = 1.02	0.65, 1.60	0.95
Bile leak	7	232	232	0.93	0	F	OR = 1.00	0.45, 2.25	0.99
Gastroente-ric anastomosis fistula	3	136	133	0.54	0	F	OR = 0.49	0.09, 2.73	0.42
Wound infection	9	332	697	0.46	0	F	OR = 0.57	0.39, 0.84	0.005
Intra-abdominal abscess	5	175	340	0.23	29%	F	OR = 0.74	0.39, 1.38	0.34
Bowel obstruction	2	73	73	0.33	0	F	OR = 1.00	0.14, 7.31	1.00
Fluid collection	2	77	77	0.96	0	F	OR = 0.63	0.21, 1.89	0.41
Pneumonia	10	463	880	0.99	0	F	OR = 0.79	0.54, 1.15	0.21
Cardiac event	4	239	648	0.48	0	F	OR = 1.11	0.75, 1.62	0.61
Reoperation	12	544	990	0.46	0	F	OR = 0.76	0.48, 1.21	0.25
ICU admission	2	171	283	0.40	0	F	OR = 0.90	0.53, 1.54	0.71
ICU stay	2	65	227	0.62	0	F	WMD = -2.08	-2.88, -1.29	< 0.00001
Diet start time	3	175	284	<0.0001	90%	R	WMD = -1.75	-3.38, -0.12	0.04
LOS	8	332	500	0.004	67%	R	WMD = -3.69	-4.90, -2.48	< 0.00001
Discharge to a new facility	3	218	490	0.60	0	F	OR = 0.50	0.28, 0.87	0.01
30-d readmission	6	340	508	0.77	0	F	OR = 1.04	0.68, 1.59	0.86
90-d readmission	4	136	279	0.70	0	F	OR = 1.07	0.62, 1.84	0.81
30-d mortality	12	527	1271	0.76	0	F	OR = 1.26	0.59, 2.68	0.55
90-d mortality	9	312	661	0.96	0	F	OR = 0.60	0.31, 1.17	0.14
Time to adjuvant chemothe-rapy	1	39	141	NA	NA	F	WMD = -5.50	-12.71, 1.71	0.14
Tumor size	9	430	745	0.0002	73%	R	WMD = -0.36	-0.63, -0.09	0.008
RLNs	10	388	925	< 0.00001	79%	R	WMD = 1.28	0.29, 2.27	0.01
R0 rate	16	605	1535	0.87	0	F	OR = 1.44	1.07, 1.94	0.02
OS of PDAC
1-yr OS	2	65	427	0.49	0	F	OR = 0.65	0.37, 1.13	0.12
2-yr OS	2	65	427	0.74	0	F	OR = 0.54	0.27, 1.07	0.08
3-yr OS	2	65	427	0.37	0	F	OR = 0.98	0.46, 2.10	0.96
4-yr OS	2	65	427	0.82	0	F	OR = 1.04	0.43, 2.52	0.93
5-yr OS	2	65	427	0.27	17%	F	OR = 0.65	0.19, 2.23	0.49
OS of periampullary adenocarcinoma patients
1-yr OS	2	23	234	0.004	88%	R	OR = 0.85	0.01, 107.31	0.95
3-yr OS	2	23	234	0.01	84%	R	OR = 0.90	0.01, 86.00	0.96
5-yr OS	2	23	234	0.26	20%	F	OR = 1.57	0.43, 5.73	0.49

NA: Not applicable; EBL: Estimated blood loss; Major morbidity: Clavien-Dindo classification ≥ III; RLNs: Retrieved lymph nodes; POPF: Postoperative pancreatic fistula; DGE: Delayed gastric emptying; PPH: Postpancreatectomy hemorrhage; LOS: Length of hospital stay; ICU: Intensive care unit; RFS: Recurrence-free survival; OS: Overall survival; PDAC: Pancreatic ductal adenocarcinoma; WMD: Weighted mean difference; OR: Odds ratio; CI: Confidence interval; F: Fixed-effects model; R: Random-effects model; TLPD: Total laparoscopic pancreaticoduodenectomy; OPD: Open pancreaticoduodenectomy.