METHODS: We searched PubMed, Cochrane, Embase, and Web of Science for studies published before February 1, 2021. Of 6578 articles, 81 were full-text reviewed. The primary outcome was mortality. Three independent reviewers screened and extracted the data and resolved disagreements by consensus. Studies were evaluated for quality using ROB2.0 and ROBINS-I. According to different study designs, sensitivity and meta-regression analyses were conducted to explore the heterogeneity source. This meta-analyses was also conducted to explore the learning curve\'s heterogeneity. This study was registered with PROSPERO, CRD42021234579.
RESULTS: We analyzed 34 studies involving 46,729 patients (4705 LPD and 42,024 OPD). LPD was associated with lower (P = 0.025) in unmatched studies (P = 0.017). No differences in mortality existed in randomized controlled trials (P = 0.854) and matched studies (P = 0.726). Sensitivity analysis found no significant difference in mortality in elderly patients, patients with pancreatic cancer, and in high- and low-volume hospitals (all P > 0.05). In studies at the early period of LPD (<40 cases), higher mortality (P < 0.001) was found (all P < 0.05).LPD showed non-inferiority in length of stay, complications, and survival outcomes in all analyses.
CONCLUSIONS: In high-volume centers with adequate surgical experience, LPD in selected patients appears to be a valid alternative to LPD with comparable mortality, LOS, complications, and survival outcomes.
方法:我们搜索了PubMed,科克伦,Embase,和WebofScience在2021年2月1日之前发表的研究。在6578篇文章中,81篇全文回顾。主要结果是死亡率。三名独立审稿人筛选并提取了数据,并以协商一致方式解决了分歧。使用ROB2.0和ROBINS-I对研究进行了质量评估。根据不同的研究设计,进行敏感性分析和meta回归分析以探索异质性来源.这项荟萃分析也是为了探索学习曲线的异质性。这项研究在PROSPERO注册,CRD42021234579。
结果:我们分析了34项研究,涉及46,729例患者(4705例LPD和42,024例OPD)。在非匹配研究(P=0.017)中,LPD与低(P=0.025)相关。随机对照试验(P=0.854)和配对研究(P=0.726)的死亡率无差异。敏感性分析发现老年患者死亡率无显著差异,胰腺癌患者,以及高容量和低容量医院(均P>0.05)。在LPD早期的研究中(<40例),发现较高的死亡率(P<0.001)(所有P<0.05)。LPD在住院时间上显示非劣,并发症,和所有分析中的生存结果。
结论:在具有足够手术经验的高容量中心,选定患者的LPD似乎是LPD的有效替代方案,死亡率相当,LOS,并发症,和生存结果。