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.