Minimally invasive pancreatoduodenectomy

Area of Science:

• Surgical Oncology
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Minimally invasive pancreatoduodenectomy (MIPD) is gaining traction, with numerous studies and institutional reports available.
• Assessing the current evidence and expert consensus on MIPD is crucial for understanding its role and future challenges.

Purpose of the Study:

• To evaluate the best available evidence and expert opinions regarding the current status of MIPD.
• To identify future challenges and research needs for minimally invasive pancreatoduodenectomy.

Main Methods:

• A systematic literature review was conducted, focusing on comparative trials of MIPD versus open pancreatoduodenectomy (OPD).
• Evidence was presented at a State-of-the-Art conference, supplemented by expert panel discussions and audience feedback.

Main Results:

• 26 comparative studies of low quality were assessed; no randomized controlled trials were identified.
• MIPD demonstrated longer operative times, reduced blood loss, and shorter hospital stays compared to OPD.
• Registry data indicated higher mortality for MIPD in low-volume centers, while oncologic outcomes were comparable.
• Expert opinion favored continued evaluation of MIPD.

Conclusions:

• MIPD offers similar perioperative and oncologic outcomes to OPD in carefully selected patients at high-volume, experienced centers.
• The precise role of MIPD in pancreatic surgery requires further definition.
• Enhanced training, registry participation, and prospective studies are necessary to advance MIPD.