TTP4.06 Open, Laparoscopic, and Robotic Pancreaticoduodenectomy: A Systematic Review

Aims Previous studies have examined outcomes of open (OPD), laparoscopic (LPD), and robotic (RPD) pancreaticoduodenectomies from randomized controlled trials (RCTs) remain limited. This study analyzed the available RCTs to directly compare the effectiveness and safety of these three surgical techniques. Methods We conducted a literature search across PubMed/MedLine, Cochrane Library, and ClinicalTrials.gov to identify RCTs. Our review adhered to PRISMA-NMA guidelines. Statistical analyses were performed using R software (v4.3.2). Outcomes were reported as odds ratios (OR) or mean differences (MD) with 95% credible intervals (CI). Heterogeneity was assessed via the I² statistic, and study quality and bias risk were evaluated using the NIH Quality Assessment Tool for Controlled Intervention Studies. Results Seven RCTs (1247 patients) were included for analysis. OPD was associated with 0.32% higher 90-day mortality than LPD (p<0.05). Post pancreatectomy hemorrhage was less frequent after OPD and RPD compared to LPD (OPD vs LPD -0.66%; RDP vs LDP -1.42%; p<0.05). Operating time was significantly longer for LPD and RPD compared to OPD (LPD vs OPD +72.6min; p=0.0018, RPD vs OPD +67.1 min; p=0.1238). No significant differences in length of hospital stay and in the incidence of complications of Clavien-Dindo grade 3 or higher were found. Conclusions Our analysis of RCTs suggests that OPD was associated with higher mortality compared to LPD and RPD. LPD and RPD were associated with longer operative times, no significant difference in complications and failed to exhibit statistically significant reduction in hospital stay, while LPD demonstrated higher rates of PPH.