Minimally-Invasive vs Open Pancreaticoduodenectomy: Systematic Review and Meta-Analysis

Laparoscopic approaches are routinely used for a variety of procedures in general surgery and various surgical specialties including surgical oncology. Since publication of the first series of laparoscopic cholecystectomy in the late 1980s, the field of minimally invasive surgery (MIS) has expanded dramatically and is now regarded as an established specialty. Many oncologic procedures have proved not only feasible and safe, but oncologically equivalent to traditional open procedures regarding both immediate operative variables of interest (margins, lymph node retrieval, and morbidity) and long-term outcomes. Pancreaticoduodenectomy (PD) poses a particular challenge. During this procedure, there is extensive retroperitoneal dissection around anatomically complex and hazardous structures, and a prolonged reconstruction that includes 3 technically demanding anastomoses. Given this complex gastrointestinal reconstruction, it has been generally thought that the minimally invasive approach would not significantly decrease recovery time (hospital stay), yet it would significantly increase operative time. Even though minimally invasive PD was reported as early as 1994, laparoscopic surgeons have been reluctant to routinely perform it. Since this first description now almost 20 years ago, a large number of single-institution series of minimally invasive (including laparoscopic-assisted, totally laparoscopic, and more