Network Meta-Analysis and Trial Sequential Analysis of Randomised Controlled Trials Comparing Robotic, Laparoscopic, and Open Pancreatoduodenectomy
Background:. The use of minimally invasive (laparoscopic and robotic) pancreatoduodenectomy (PD) is being increasingly adopted despite the lack of hard evidence to support its utilisation. With recent randomised controlled trials (RCTs) comparing open pancreatoduodenectomy (OPD) with robotic or lapa...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2024-12-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000507 |
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| author | Nejo Joseph, MBChB Chris Varghese, MBChB James Lucocq, MBChB Matthew J. McGuinness, MBChB Samuel Tingle, MBChB Giovanni Marchegiani, PhD Kjetil Soreide, PhD Mohammed Abu-Hilal Jas Samra Marc Besselink, PhD Steve White Sanjay Pandanaboyana, FRCS |
| author_facet | Nejo Joseph, MBChB Chris Varghese, MBChB James Lucocq, MBChB Matthew J. McGuinness, MBChB Samuel Tingle, MBChB Giovanni Marchegiani, PhD Kjetil Soreide, PhD Mohammed Abu-Hilal Jas Samra Marc Besselink, PhD Steve White Sanjay Pandanaboyana, FRCS |
| author_sort | Nejo Joseph, MBChB |
| collection | DOAJ |
| description | Background:. The use of minimally invasive (laparoscopic and robotic) pancreatoduodenectomy (PD) is being increasingly adopted despite the lack of hard evidence to support its utilisation. With recent randomised controlled trials (RCTs) comparing open pancreatoduodenectomy (OPD) with robotic or laparoscopic pancreatoduodenectomy (RPD or LPD), we undertook a network meta-analysis (NMA) comparing all 3 approaches to evaluate comparative outcomes.
Methods:. A systematic search of MEDLINE, EMBASE, and Cochrane CENTRAL was conducted up to May 2024 and relevant RCTs were identified. A random-effects meta-analysis and trial sequential analysis (TSA) were conducted for primary outcomes, followed by a Bayesian NMA of length of stay (LOS), duration of surgery, intraoperative blood loss, and pancreas resection-related outcomes
Results:. Seven RCTs involving 1336 patients were included, 5 investigating LPD compared with OPD and 2 RPD to OPD. Pairwise meta-analysis indicated that LPD was associated with shorter hospital stay (mean difference [MD], −1.39; 95% confidence interval [CI], −2.33 to −0.45) and lower intraoperative blood loss compared with OPD (MD, −131; 95% CI, −146 to −117). However, LPD was associated with significantly longer operative duration (MD, 39.5; 95% CI, 34–45). TSA confirmed the robustness of the positive and negative findings on pairwise meta-analysis. In comparison, there were no significant differences between RPD and OPD in pairwise meta-analysis, which could not be confirmed by TSA. Network meta-analysis tended to favour LPD in most outcome parameters including LOS, duration of surgery, and pancreas resection-related outcomes.
Conclusions:. The current RCT evidence suggests potential better outcomes in LPD in comparison with RPD and OPD. However, few studies demonstrated robust statistical significance in outcome measures, suggesting an underpowered evidence base and possible selection bias. Hence, with current equivocal data, there is a need for ongoing RCTs to validate the role of minimally invasive approaches in PD. |
| format | Article |
| id | doaj-art-f99295f23b9a417cb96a8586be8771e0 |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-f99295f23b9a417cb96a8586be8771e02025-01-24T09:18:58ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932024-12-0154e50710.1097/AS9.0000000000000507202412000-00028Network Meta-Analysis and Trial Sequential Analysis of Randomised Controlled Trials Comparing Robotic, Laparoscopic, and Open PancreatoduodenectomyNejo Joseph, MBChB0Chris Varghese, MBChB1James Lucocq, MBChB2Matthew J. McGuinness, MBChB3Samuel Tingle, MBChB4Giovanni Marchegiani, PhD5Kjetil Soreide, PhD6Mohammed Abu-Hilal7Jas Samra8Marc Besselink, PhD9Steve White10Sanjay Pandanaboyana, FRCS11From the * Department of Surgery, University of Auckland, Auckland, New ZealandFrom the * Department of Surgery, University of Auckland, Auckland, New Zealand† Department of General Surgery, NHS Lothian, Edinburgh, United Kingdom‡ Department of General Surgery, North Shore Hospital, Auckland, New Zealand§ Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom‖ Department of Surgery, Oncology, and Gastroenterology (DiSCOG), University of Padua, Padua, Italy¶ Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway# Department of HPB Surgery, University Hospital Southampton, Southampton, United Kingdom** Department of HPB Surgery, Royal North Shore Hospital, Sydney, NSW, Australia†† Department of Surgery, UMC Amsterdam, Amsterdam, The Netherlands‡‡ HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom‡‡ HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United KingdomBackground:. The use of minimally invasive (laparoscopic and robotic) pancreatoduodenectomy (PD) is being increasingly adopted despite the lack of hard evidence to support its utilisation. With recent randomised controlled trials (RCTs) comparing open pancreatoduodenectomy (OPD) with robotic or laparoscopic pancreatoduodenectomy (RPD or LPD), we undertook a network meta-analysis (NMA) comparing all 3 approaches to evaluate comparative outcomes. Methods:. A systematic search of MEDLINE, EMBASE, and Cochrane CENTRAL was conducted up to May 2024 and relevant RCTs were identified. A random-effects meta-analysis and trial sequential analysis (TSA) were conducted for primary outcomes, followed by a Bayesian NMA of length of stay (LOS), duration of surgery, intraoperative blood loss, and pancreas resection-related outcomes Results:. Seven RCTs involving 1336 patients were included, 5 investigating LPD compared with OPD and 2 RPD to OPD. Pairwise meta-analysis indicated that LPD was associated with shorter hospital stay (mean difference [MD], −1.39; 95% confidence interval [CI], −2.33 to −0.45) and lower intraoperative blood loss compared with OPD (MD, −131; 95% CI, −146 to −117). However, LPD was associated with significantly longer operative duration (MD, 39.5; 95% CI, 34–45). TSA confirmed the robustness of the positive and negative findings on pairwise meta-analysis. In comparison, there were no significant differences between RPD and OPD in pairwise meta-analysis, which could not be confirmed by TSA. Network meta-analysis tended to favour LPD in most outcome parameters including LOS, duration of surgery, and pancreas resection-related outcomes. Conclusions:. The current RCT evidence suggests potential better outcomes in LPD in comparison with RPD and OPD. However, few studies demonstrated robust statistical significance in outcome measures, suggesting an underpowered evidence base and possible selection bias. Hence, with current equivocal data, there is a need for ongoing RCTs to validate the role of minimally invasive approaches in PD.http://journals.lww.com/10.1097/AS9.0000000000000507 |
| spellingShingle | Nejo Joseph, MBChB Chris Varghese, MBChB James Lucocq, MBChB Matthew J. McGuinness, MBChB Samuel Tingle, MBChB Giovanni Marchegiani, PhD Kjetil Soreide, PhD Mohammed Abu-Hilal Jas Samra Marc Besselink, PhD Steve White Sanjay Pandanaboyana, FRCS Network Meta-Analysis and Trial Sequential Analysis of Randomised Controlled Trials Comparing Robotic, Laparoscopic, and Open Pancreatoduodenectomy Annals of Surgery Open |
| title | Network Meta-Analysis and Trial Sequential Analysis of Randomised Controlled Trials Comparing Robotic, Laparoscopic, and Open Pancreatoduodenectomy |
| title_full | Network Meta-Analysis and Trial Sequential Analysis of Randomised Controlled Trials Comparing Robotic, Laparoscopic, and Open Pancreatoduodenectomy |
| title_fullStr | Network Meta-Analysis and Trial Sequential Analysis of Randomised Controlled Trials Comparing Robotic, Laparoscopic, and Open Pancreatoduodenectomy |
| title_full_unstemmed | Network Meta-Analysis and Trial Sequential Analysis of Randomised Controlled Trials Comparing Robotic, Laparoscopic, and Open Pancreatoduodenectomy |
| title_short | Network Meta-Analysis and Trial Sequential Analysis of Randomised Controlled Trials Comparing Robotic, Laparoscopic, and Open Pancreatoduodenectomy |
| title_sort | network meta analysis and trial sequential analysis of randomised controlled trials comparing robotic laparoscopic and open pancreatoduodenectomy |
| url | http://journals.lww.com/10.1097/AS9.0000000000000507 |
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