Minimally invasive pancreatoduodenectomy is as safe and efficacious as open surgery for pancreatic ductal adenocarcinoma: a meta-analysis

Minimally invasive pancreaticoduodenectomy (MIPD) remains to be established as a safe and effective alternative to open pancreaticoduodenectomy (OPD) for pancreatic ductal adenocarcinoma (PDAC). The aim of this meta-analysis was to compare MIPD with OPD for PDAC with regards to perioperative and oncologic outcomes. A literature search, up to April 2018, was performed to identify comparative studies reporting outcomes for both MIPD and OPD for PDAC. Postoperative pancreatic fistula (POPF), morbidity, mortality, operation time, blood loss, transfusion, hospital stay, retrieved lymph nodes, and survival outcomes were compared. Of the seven identified studies, 1,055 underwent LPD and 8,116 underwent OPD. Pooled data showed that MIPD was associated with less morbidity (OR=0.61, 95% CI: 0.37 similar to 1.01, P=0.05), less blood loss (WMD=-372.96 mL, 95% CI: -507.83 similar to-238.09, P<0.01), and shorter hospital stay (WMD=-1.69 days, 95% CI: -3.27 similar to-0.12, P=0.04), with comparable POPF (OR=0.90, 95% CI: 0.52 similar to 1.56, P=0.70) and overall survival (HR=1.04, 95% CI: 0.90 similar to 1.20, P=0.61), compared to OPD. Operative times were longer in MIPD (WMD=66.95 min, 95% CI: -81.22 similar to 215.12, P=0.38) and retrieved lymph nodes tended to be more in MIPD (WMD=1.93, 95% CI: -0.35 similar to 4.22, P=0.10). These differences, however, failed to reach statistical significance. MIPD can be performed as safely and effectively as OPD for PDAC, comparing surgical and oncological outcomes. MIRH is associated with less intraoperative blood loss and postoperative morbidity, serving as a promising alternative to OPD in selected individuals.