Minimally invasive versus open pancreaticoduodenectomy for periampullary tumors: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Background: Minimally invasive pancreaticoduodenectomy (MIPD) is used more commonly, but this surge is mostly based on observational data. This meta-analysis aimed to compare the short-term outcomes between MIPD and open pancreaticoduodenectomy (OPD) using data collected from randomized controlled trials (RCTs).

Methods: We searched PubMed, Cochrane Library, Embase, and Web of Science databases for RCTs comparing MIPD and OPD published before December 10, 2024. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated.

Results: A total of eight studies were included, including two studies evaluating robotic PD (RPD) and six studies evaluating laparoscopic PD (LPD). Although MIPD was associated with a longer operative time (MD, 49.90 min; 95% CI, 27.53, 72.27, P < 0.0001), patients may benefit from reduced blood loss (MD, - 96.55 mL; 95% CI, - 145.25, - 47.86, P = 0.0001), and shorter length of stay (MD, - 1.01 days; 95% CI, - 1.74, - 0.27, P = 0.007). There were no significant differences observed in readmission (RR, 1.04), 90-day mortality (RR, 1.13), overall morbidity (RR, 0.99), major complications (RR, 1.04), postoperative pancreatic fistula (RR, 0.98), postpancreatectomy hemorrhage (RR, 0.98), delayed gastric emptying (RR, 0.93), number of harvested lymph nodes (MD, 0.39), and R0 resection (RR, 1.00) between the groups. In addition, the subgroup results showed that both RPD (MD, -90.54 mL; 95% CI, - 125.39, - 55.69, P < 0.00001) and LPD (MD, - 100.64 mL; 95% CI, - 163.23, - 38.06, P = 0.002) reduced the intraoperative blood loss.

Conclusions: Although some short-term outcomes were similar between MIPD and OPD, MIPD exhibited reduced intraoperative blood loss and shorter hospital stay. In the future, MIPD may become a safe and effective alternative to OPD.