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Background <p>Pancreatoduodenectomy (PD) is performed using open, laparoscopic, or robotic techniques, but their relative perioperative outcomes remain unclear. This review compares these approaches using evidence from randomized trials.</p> Methods <p>A systematic review and Bayesian network meta-analysis of RCTs comparing open, laparoscopic, and robotic PD was conducted following PRISMA-NMA guidelines. Data extraction, risk of bias (RoB2), and evidence certainty (GRADE) were performed by two independent reviewers. Primary outcomes included operative time, blood loss, length of stay, and complications. Bayesian models estimated pooled effects and treatment rankings, and Trial Sequential Analysis (TSA) assessed the robustness of evidence.</p> Results <p>Differences between approaches were not statistically significant for most outcomes, and credible intervals were wide. Network meta-analysis of 9 studies suggested that laparoscopic PD ranked highest for reducing intraoperative blood loss (SUCRA 80.3), length of stay (SUCRA 75.5), surgical site infection (SUCRA 90.2), postoperative pancreatic fistula (SUCRA 86.7), and delayed gastric emptying (SUCRA 77.8). Open PD ranked highest for operative time (SUCRA 74.5) and preventing bile leakage (SUCRA 63.5), while robotic PD ranked highest for preventing 90-day mortality (SUCRA 89.6). TSA indicated conclusive evidence only for shorter operative time with open PD, while all other outcomes remained underpowered and uncertain, necessitating further trials.</p> Conclusion <p>Laparoscopic PD ranked highest for reducing intraoperative blood loss, shortening hospital stay, and minimizing certain postoperative complications, while open PD ranked highest for shorter operative time and reducing bile leakage. However, most differences between approaches were not statistically significant, and credible intervals were wide, indicating uncertainty. Further high-quality, adequately powered trials are needed to confirm these findings and guide optimal selection of the surgical approach.</p>

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Optimizing surgical strategy for pancreatoduodenectomy: a network meta-analysis and trial sequential analysis

  • 期刊论文

  • 发表日期：

    2026年2月17日

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  • Alzahra’a Al Matairi,
  • Bara M. Hammadeh,
  • Omar Abuhashem,
  • Mohammad A. Zaied,
  • Moath Naser,
  • Ahmed Badr,
  • Mohamad Ezzeldin

摘要

Background

Pancreatoduodenectomy (PD) is performed using open, laparoscopic, or robotic techniques, but their relative perioperative outcomes remain unclear. This review compares these approaches using evidence from randomized trials.

Methods

A systematic review and Bayesian network meta-analysis of RCTs comparing open, laparoscopic, and robotic PD was conducted following PRISMA-NMA guidelines. Data extraction, risk of bias (RoB2), and evidence certainty (GRADE) were performed by two independent reviewers. Primary outcomes included operative time, blood loss, length of stay, and complications. Bayesian models estimated pooled effects and treatment rankings, and Trial Sequential Analysis (TSA) assessed the robustness of evidence.

Results

Differences between approaches were not statistically significant for most outcomes, and credible intervals were wide. Network meta-analysis of 9 studies suggested that laparoscopic PD ranked highest for reducing intraoperative blood loss (SUCRA 80.3), length of stay (SUCRA 75.5), surgical site infection (SUCRA 90.2), postoperative pancreatic fistula (SUCRA 86.7), and delayed gastric emptying (SUCRA 77.8). Open PD ranked highest for operative time (SUCRA 74.5) and preventing bile leakage (SUCRA 63.5), while robotic PD ranked highest for preventing 90-day mortality (SUCRA 89.6). TSA indicated conclusive evidence only for shorter operative time with open PD, while all other outcomes remained underpowered and uncertain, necessitating further trials.

Conclusion

Laparoscopic PD ranked highest for reducing intraoperative blood loss, shortening hospital stay, and minimizing certain postoperative complications, while open PD ranked highest for shorter operative time and reducing bile leakage. However, most differences between approaches were not statistically significant, and credible intervals were wide, indicating uncertainty. Further high-quality, adequately powered trials are needed to confirm these findings and guide optimal selection of the surgical approach.