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Updated: Jun 26, 2026
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Minimally Invasive Versus Open Pancreatoduodenectomy: A Systematic Review and Meta-Analysis of Randomized Controlled
Johannes M A Toti1,2, Raffaello Roesel2, Adrian T Billeter1
1From the Department of Surgery, Clarunis - University Centre for Gastrointestinal and Hepatopancreatobiliary Diseases, Basel, Switzerland.
Objective:
To compare perioperative outcomes of minimally invasive pancreatoduodenectomy (MIPD) to open pancreatoduodenectomy (OPD) using evidence from randomized controlled trials (RCTs).
Background:
The wider adoption of MIPD has largely been fueled by observational studies rather than high-level evidence.
Methods:
We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Web of Science for RCTs comparing MIPD with OPD in adult patients with benign or malignant conditions requiring elective pancreatoduodenectomy. The primary outcomes were 90-day mortality, the comprehensive complication index, Clavien-Dindo grade ≥III complications, and hospital length of stay (LOS). Secondary outcomes included postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), blood loss, reoperation, operative time, and oncologic outcomes. Data were pooled as odds ratios or mean differences using a random-effects model. Risk of bias was assessed using the Cochrane risk of bias tool, and the certainty of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation approach (PROSPERO ID: CRD42024592919).
Results:
Ten RCTs with a total of 1794 patients were included. Meta-analysis showed there were no significant differences regarding 90-day mortality, Clavien-Dindo ≥3 complications, POPF, DGE, PPH, reoperation, readmission, or oncologic outcomes between MIPD and OPD. LOS was reduced for MIPD. No clinically relevant differences were found in the subgroup analyses of laparoscopic and robotic pancreatoduodenectomy. Certainty of evidence was moderate to low.
Conclusions:
MIPD showed no clinically relevant advantages over OPD. These findings were consistent both for the robotic and laparoscopic approach.
Insights
Minimally invasive pancreatoduodenectomy (MIPD) offers no significant advantages over open pancreatoduodenectomy (OPD) in major complications or mortality. While MIPD did reduce hospital length of stay, overall clinical benefits were not evident.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Evidence-Based Medicine
Background:
- Minimally invasive pancreatoduodenectomy (MIPD) adoption is increasing, yet its evidence base relies heavily on observational studies.
- High-level evidence from randomized controlled trials (RCTs) is crucial for validating MIPD's benefits over open pancreatoduodenectomy (OPD).
Purpose of the Study:
- To compare perioperative outcomes of MIPD versus OPD using high-quality evidence from RCTs.
- To assess the safety and efficacy of MIPD in elective pancreatoduodenectomy procedures.
Main Methods:
- Systematic review and meta-analysis of 10 RCTs involving 1794 adult patients undergoing elective pancreatoduodenectomy.
- Primary outcomes included 90-day mortality, comprehensive complication index, severe complications (Clavien-Dindo grade ≥III), and hospital length of stay (LOS).
- Secondary outcomes encompassed postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), operative time, blood loss, reoperation, and oncologic outcomes.
Main Results:
- No significant differences were observed between MIPD and OPD for 90-day mortality, severe complications, POPF, DGE, PPH, reoperation, readmission, or oncologic outcomes.
- Hospital LOS was significantly reduced in the MIPD group compared to OPD.
- Subgroup analyses of laparoscopic and robotic approaches revealed no clinically relevant differences between MIPD and OPD.
Conclusions:
- MIPD does not demonstrate clinically relevant advantages over OPD in terms of major perioperative outcomes.
- The findings hold true for both laparoscopic and robotic minimally invasive techniques.
- The certainty of evidence supporting these conclusions ranges from moderate to low.
