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Updated: Mar 23, 2026
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Systematic review and meta-analysis of minimally invasive versus open approach for pancreaticoduodenectomy
Hang Zhang1, XiangHu Wu1, Feng Zhu1
1Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China.
Backgrounds And Objective:
The technique of minimally invasive pancreatic surgeries has evolved rapidly, including minimally invasive pancreaticoduodenectomy (MIPD). However, controversy on safety and feasibility remains when comparing the MIPD with the open pancreaticoduodenectomy (OPD); therefore, we aimed to compare MIPD and OPD with a systemic review and meta-analysis.
Methods:
Multiple electronic databases were systematically searched to identify studies (up to February 2016) comparing MIPD with OPD. Intra-operative outcomes, oncologic data, postoperative complications and postoperative recovery were evaluated.
Results:
Twenty-two retrospective studies including 6120 patients (1018 MIPDs and 5102 OPDs) were included. MIPD was associated with a reduction in estimated blood loss (WMD -312.00 ml, 95 % CI -436.30 to -187.70 ml, p < 0.001), transfusion rate (OR 0.41, 95 % CI 0.30-0.55, p < 0.001), wound infection (OR 0.37, 95 % CI 0.20-0.66, p < 0.001) and length of hospital stay (WMD -3.57 days, 95 % CI -5.17 to -1.98 days, p < 0.001). Meanwhile, MIPD group has a higher R0 resection rate (OR 1.47, 95 % CI 1.18-1.82, p < 0.001) and more lymph nodes harvest (WMD 1.74, 95 % CI 1.03-2.45, p < 0.001). However, it had longer operation time (WMD 83.91 min, 95 % CI 36.60-131.21 min, p < 0.001). There were no significant differences between the two procedures in morbidities (p = 0.86), postoperative pancreatic fistula (p = 0.17), delayed gastric empting (p = 0.65), vascular resection (p = 0.68), reoperation (p = 0.33) and mortality (p = 0.90).
Conclusions:
MIPD can be a reasonable alternative to OPD with potential advantages. However, further large-volume, well-designed RCTs with extensive follow-ups are suggested to confirm and update the findings of our analysis.
Insights
Minimally invasive pancreaticoduodenectomy (MIPD) offers reduced blood loss, infection, and hospital stay compared to open pancreaticoduodenectomy (OPD). While MIPD shows oncologic advantages, further trials are needed to confirm its benefits in pancreatic surgery.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Minimally invasive pancreaticoduodenectomy (MIPD) is an evolving surgical technique.
- Controversy exists regarding the safety and feasibility of MIPD compared to open pancreaticoduodenectomy (OPD).
Purpose of the Study:
- To systematically review and compare the outcomes of MIPD and OPD.
- To evaluate intra-operative results, oncologic data, postoperative complications, and recovery between MIPD and OPD.
Main Methods:
- Systematic search of multiple electronic databases up to February 2016.
- Inclusion of 22 retrospective studies involving 6120 patients (1018 MIPDs, 5102 OPDs).
- Evaluation of intra-operative outcomes, oncologic data, postoperative complications, and recovery.
Main Results:
- MIPD demonstrated significantly reduced blood loss, transfusion rates, wound infections, and hospital stay.
- MIPD was associated with higher R0 resection rates and more lymph node harvests but longer operation times.
- No significant differences were observed in overall morbidities, pancreatic fistula, delayed gastric emptying, vascular resection, reoperation, or mortality.
Conclusions:
- MIPD presents a viable alternative to OPD with notable advantages.
- Further large-scale, well-designed randomized controlled trials are recommended to validate these findings.
