<p> Operative time in minutes (β, p value) Intraoperative blood loss in mL (β, p value) Covariates B vs A D vs A E vs A B vs C vs A D vs A E vs A A 1015 Country (Eastern , * 152, 0.012 * -377,0.936 38,0.646 * vs Western) <0.0 01 Matching for age * 13,0.570 * * 225, 0.372 * * (No vs. Yes) Matching for gender (No vs. * * * * * * * Yes) 1025 Matching for BMI -51, 0.379 * * ,<0.0 415,0.257 * * (No vs. Yes) 01 Matching for pancreatic texture * * * * * * * (No vs. Yes) Matching for PDAC resected * * 29,0.277 * * * * (No vs. Yes) Matching for malignancy (No * * * * * * * vs. Yes) Completed Learning curve in * * * * -143,0.497 23,0.996 * MIPD (No vs. Yes) HPB Surgeon (No * * * * -218,0.300 * vs. Yes) ITT (no vs. Yes) * -215,<0.001 * * * * * 90 days mortality * * * * * * * (No vs. Yes) ISGPF definition * * * * * * * (No vs. Yes) ISGPF definition * * * * * * * (No vs. Yes) Clavien- Dindo adoption (No vs. * * * * * * * Yes) MINORS (< 16 or ≥ * * * * 361,0.938 * * 16) Supplemetary table 3 a: Meta-regression for operative time and intraoperative blood loLegend: BMI: Body Mass Index; PDAC: Pancreatic Ductal Adenocarcinoma; HPB: Hepato-Biliary Pancreatic Surgeon; ITT:Intention To Treat analysis ; OR: odds ratio; A: Open Pancreatico-Duodenectomy; B: Laparoscopic Assisted Pancreatico-Duodenectomy; C: Totally Robotic Pancreatico-Duodenectomy; D: Totally Laparoscopic Pancreatico- Duodenectomy; E: Totally Laparoscopic Pancreatico-Duodenectomy-Robotic Assisted (arm E); ISGPF: International Study Group of Pancreatic Fistula classificatio ; ISGPS: International Study Group of Pancreatic Surgery; Clavien-Dindo: Postoperative course classified according to the Clavien-Dindo classification; *co-linearity. </p><p>Supplemetary table 3 b: Meta-regression for length of stay and harvested lymph nodes. </p><p>Length of stay in days (β, p value) Harvested lymph nodes (β, p value) Covariates B vs A D vs A E vs A B vs C vs A D vs A E vs A A Country (Eastern vs. * 3.9, 0.525 * * 5.8, 0.018 1.4,0.698 * Western) Matching for age * 2.0, 0.784 * * * * * (No vs. Yes) Matching for gender * * * * * * * (No vs. Yes) Matching for BMI * * * * 4.1, 0.012 * * (No vs. Yes) Matching for pancreatic * * * * * * * texture (No vs. Yes) Matching for PDAC resected * 2.0, 0.760 * * * -1.7, 0.734 -5.8,0.003 (No vs. Yes) Matching for malignancy * * * * 1.4, 0.570 * * (No vs. Yes) Completed * 5.5, 0.984 * 3.7, 3.0, 0.066 -1.2, 0.842 * Learning curve in 0.33 MIPD (No vs. 6 Yes) HPB Surgeon * * * * * * (No vs. Yes) * ITT (No vs. Yes) * * * * * 0.06, 0.992 * 90 days mortality * * * * * * * (No vs. Yes) ISGPF definition * * * * * * * (No vs. Yes) ISGPF definition * * * * * * * (No vs. Yes) Clavien-Dindo adoption (No vs. * * * * * * * Yes) MINORS (< 16 or * * * * 4.0, 0.248 1.1,0.746 5.8,0.175 ≥ 16) Legend: BMI: Body Mass Index; PDAC: Pancreatic Ductal Adenocarcinoma; HPB: Hepato-Biliary Pancreatic Surgeon; ITT=Intention-To-Treat analysis; OR: odds ratio; A: Open Pancreatico-Duodenectomy; B: Laparoscopic Assisted Pancreatico-Duodenectomy; C: Totally Robotic Pancreatico-Duodenectomy; D: Totally Laparoscopic Pancreatico-Duodenectomy; E: Totally Laparoscopic Pancreatico-Duodenectomy-Robotic Assisted (arm E); ISGPF:International Study Group of Pancreatic Fistula classification; ISGPS: International Study Group of Pancreatic Surgery; Clavien-Dindo: Postoperative course classified according to the Clavien-Dindo classification; *co-linearity</p>