Minimally Invasive versus Open Pancreaticoduodenectomy for Periampullary Tumors

Abstract

Introduction: Pancreaticoduodenectomy remains a technically challenging procedure. Adoption of minimally invasive approaches has been slow due to concerns about safety and oncologic adequacy. This review compares outcomes of laparoscopic and robotic pancreaticoduodenectomy versus open surgery.

Methods: A literature review was performed using MEDLINE and Cochrane Library for comparative studies and meta-analyses. Primary outcomes were major morbidity (Clavien-Dindo III–V), R0 resection rate, and lymph node harvest. Secondary outcomes included operative time and hospital stay.

Results: Twenty-two studies comprising over ten thousand patients were analyzed. Minimally invasive pancreaticoduodenectomy was associated with longer operative time but shorter hospital stay and less blood loss. Major morbidity and pancreatic fistula rates were similar between approaches. R0 resection rates were comparable, and lymph node harvest was equivalent or slightly higher in the minimally invasive group.

Discussion: The learning curve for minimally invasive pancreaticoduodenectomy is steep, with decreased complications after forty to eighty cases. Robotic assistance may reduce the conversion rate and facilitate intracorporeal reconstruction. While early series raised safety concerns, recent high-volume center data show non-inferiority. Patient selection, particularly excluding borderline resectable tumors, may influence results.

Conclusions: In experienced hands, minimally invasive pancreaticoduodenectomy is safe and achieves similar oncologic outcomes to open surgery. Ongoing prospective registries will further define its role.