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Updated: May 28, 2025
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Minimal Invasive Pancreatoduodenectomy: A Comprehensive Systematic Review and Metanalysis of Randomized Controlled
Claudio Ricci1, Vincenzo D'Ambra2, Laura Alberici2
1Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy. claudio.ricci6@unibo.it.
Background:
The role of a minimally invasive approach (MI) in patients who underwent pancreatoduodenectomy (PD) remained unclear.
Methods:
A systematic search of randomized controlled trials was conducted. A random-effects meta-analysis was conducted, reporting risk ratio (RR) or mean difference (MD). The primary endpoints were the morbidity, mortality, and R1 rate. The secondary endpoints were clinically relevant postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH), delayed gastric emptying (DGE), biliary fistula, reoperation, length of stay (LOS), time to functional recovery (TFR), and readmission.
Results:
The meta-analysis includes seven studies and 1428 patients: 618 (46.5%) in the OPD arm and 711 (53.5%) in minimally invasive pancreaticoduodenectomy (MIPD). The mortality rate was 2.9% for MIPD and 2.6% for OPD (RR 1.11 [range 0.53-2.29]). The major morbidity rate was 29.4% for MIPD and 25.6% for OPD (RR 1.11 [range 0.53-2.29]). The R1 rate was 6.2% for MIPD and 7% for OPD (RR 0.80 [0.54-1.20]). The operative time, comprehensive complication index score, POPF, PPH, DGE, biliary fistula, reoperation, readmission, LOS, TFR, and harvested lymph nodes were similar. Greater than 25% of heterogeneity was observed for major morbidity, operative time, POPF, LOS, TFR, and harvested lymph nodes. No publication bias was registered.
Conclusions:
Minimally invasive pancreaticoduodenectomy was not superior to OPD and provided marginal advantages in short-term results. Further efforts should be addressed to clarify the impact of learning curve in MIPD results and the economic sustainability of MIPD, particularly robotic approach.
Insights
Minimally invasive pancreaticoduodenectomy (MIPD) shows no superiority over open pancreatoduodenectomy (OPD) but offers slight short-term benefits. Further research is needed on MIPD
Area of Science:
- Surgical Oncology
- Gastroenterology
- Minimally Invasive Surgery
Background:
- The comparative effectiveness of minimally invasive (MI) versus open pancreatoduodenectomy (PD) remains uncertain.
- Pancreaticoduodenectomy is a complex procedure with significant associated risks.
Purpose of the Study:
- To systematically evaluate the safety and efficacy of minimally invasive pancreaticoduodenectomy (MIPD) compared to open pancreatoduodenectomy (OPD).
- To analyze primary outcomes including morbidity, mortality, and R1 resection rates.
Main Methods:
- A systematic review and random-effects meta-analysis of randomized controlled trials.
- Inclusion of seven studies with 1428 patients (618 MIPD, 711 OPD).
- Assessment of primary (morbidity, mortality, R1 rate) and secondary endpoints (POPF, PPH, DGE, LOS, TFR, etc.).
Main Results:
- No significant differences in mortality (2.9% MIPD vs. 2.6% OPD) or major morbidity (29.4% MIPD vs. 25.6% OPD).
- Similar R1 resection rates (6.2% MIPD vs. 7% OPD).
- Comparable outcomes for operative time, complications, and recovery metrics between MIPD and OPD.
Conclusions:
- Minimally invasive pancreaticoduodenectomy (MIPD) does not demonstrate superiority over open pancreatoduodenectomy (OPD).
- MIPD may offer marginal short-term advantages.
- Further investigation into the learning curve and economic viability of MIPD, especially robotic approaches, is warranted.
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