S2310 Comparing Robotic, Laparoscopic and Open Pancreaticoduodenectomy: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials and Propensity-Matched Studies
Bibliographic record
Abstract
Introduction: Pancreaticoduodenectomy is a complicated procedure with a high risk of morbidity and mortality. This network meta-analysis compared the robotic (RPD), laparoscopic (LPD) and open (OPD) approaches for pancreaticoduodenectomy. Methods: PubMed, Cochrane Central and ScienceDirect were searched from inception till January 2025. A frequentist network meta-analysis was performed using the R version 4.2.1 and employing the “netmeta” package. Risk ratios (RR) with a 95% Confidence interval were pooled under the random effects model for the dichotomous outcomes. The treatment ranking was calculated using the P-scores. The quality of the included studies was evaluated using the Cochrane Rob 2 tool and the New-castle Ottawa Scale, while the publication bias was assessed using the funnel plots. Results: Fifty-five studies were included in the final meta-analysis. Compared with OPD, RPD significantly decreased the risk of overall complications (RR = 0.84, 95% CI: [0.72, 0.97). The risk of major complications was lowest in the RPD (P-score = 0.95) and highest in the OPD group (0.13). RPD also had the lowest risk of postoperative pancreatic fistula rate (POPF) (0.42), while the risk of delayed gastric emptying (DGE) was lowest in the LPD group (P-score = 1.0). The R0 resection rate was highest in the LPD (0.72) and lowest in the RPD group (0.39). Regarding 90-day mortality, RPD had the lowest risk (P-score = 0.72). Conclusion: RPD demonstrates a lower risk of overall complications and postoperative pancreatic fistula compared to OPD, while LPD has a lower risk of delayed gastric emptying and higher R0 resection rates. Both RPD and LPD offer promising outcomes, with RPD showing the most favourable results in reducing 90-day mortality.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Review About the Canadian research system: no · About a Canadian topic: no | Meta-analysis | low |
| gpt | Meta-epidemiology (broad) Domain: not available · Genre: Review About the Canadian research system: no · About a Canadian topic: no | Meta-analysis | medium |
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.065 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
The models disagree on parts of this classification; every voice is preserved in the section at the end of the page.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".