Minimally Invasive Versus Open Pancreatoduodenectomy: A Systematic Review and Meta-Analysis of Randomized Controlled...

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.