Minimally invasive vs open pancreaticoduodenectomy for periampullary tumors: A systematic review and updated meta-analysis.

Abstract

e16474 Background: Laparoscopic pancreaticoduodenectomy (LPD) is increasingly being performed for periampullary tumors. However, its safety and efficacy compared to open pancreaticoduodenectomy (OPD) remain debated. LPD is a complex procedure that requiresadvanced laparoscopic skills. This meta-analysis aims to compare the outcomes of LPD and OPD. Methods: We systematically searched electronic databases, including PubMed, Embase, and the Cochrane Library, from inception through January 2026 to compare LPD with OPD and analyze the following outcomes: mortality, morbidity, major complications, delayed gastric emptying, postoperative pancreatic fistula, postoperative pancreatic hemorrhage, R0 resection rate, readmission, operative time, blood loss, hospital stay, and lymph nodes harvested. Forest plots were generated, and data were analyzed using a random-effects model to calculate pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs); heterogeneity was assessed using I² statistics. Results: A total of nine studies (n = 1,491) were included, comparing LPD (n = 752) with OPD (n = 739). LPD was associated with a significantly shorter hospital stay (MD 1.01, 95% CI 0.27–1.74, P = 0.0071, I² = 31.4%) and less blood loss (MD −97.23, 95% CI −149.15 to −45.31, P = 0.0002, I² = 87.7%) compared with OPD. However, LPD was associated with a longer operative time (MD −53.22, 95% CI −89.70 to −16.74, P = 0.0042, I² = 90.7%). There were no significant differences in mortality (RR 1.09, 95% CI 0.49–2.41, P = 0.8293, I² = 12.3%), morbidity (RR 1.01, 95% CI 0.89–1.14, P = 0.9144, I² = 0.0%), major complications (RR 1.13, 95% CI 0.83–1.55, P = 0.4366, I² = 50.1%), delayed gastric emptying (RR 1.09, 95% CI 0.79–1.49, P = 0.6028, I² = 47.2%), postoperative pancreatic fistula (RR 1.03, 95% CI 0.77–1.33, P = 0.9303, I² = 0.0%), postoperative pancreatic hemorrhage (RR 1.03, 95% CI 0.76–1.41, P = 0.8300, I² = 0.0%), R0 resection rate (RR 1.01, 95% CI 0.99–1.03, P = 0.5658, I² = 1.9%), readmission (RR 0.97, 95% CI 0.68–1.39, P = 0.8712, I² = 0.0%), or lymph nodes harvested (MD 0.17, 95% CI −9.97 to 10.31, P = 0.9741, I² = 0.0%). Conclusions: Laparoscopic pancreaticoduodenectomy is associated with a shorter hospital stay and less blood loss but a longer operative time compared with OPD, with similar postoperative outcomes, suggesting that LPD is a safe and feasible approach for periampullary tumors in selected patients.