Minimally invasive versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: Individual patient data meta- analysis of randomized trials

Objective: Assessment of minimally invasive pancreatoduodenectomy (MIPD) in patients with pancreatic ductal adenocarcinoma (PDAC) is scarce and limited to non-randomized studies. This study aimed to compare oncological and surgical outcomes after MIPD compared to open pancreatoduodenectomy (OPD) for patients after resectable PDAC from published randomized controlled trials (RCTs).Methods: A systematic review was performed to identify RCTs comparing MIPD and OPD including PDAC (Jan 2015eJuly 2021). Individual data of patients with PDAC were requested. Primary outcomes were R0 rate and lymph node yield. Secondary outcomes were blood-loss, operation time, major complications, hospital stay and 90-day mortality.Results: Overall, 4 RCTs (all addressed laparoscopic MIPD) with 275 patients with PDAC were included. In total, 128 patients underwent laparoscopic MIPD and 147 patients underwent OPD. The R0 rate (risk difference(RD) -1%, P = 0.740) and lymph node yield (mean difference(MD) +1.55, P = 0.305) were comparable between laparoscopic MIPD and OPD. Laparoscopic MIPD was associated with less periop-erative blood-loss (MD-91ml, P = 0.026), shorter length of hospital stay (MD-3.8 days, P = 0.044), while operation time was longer (MD +98.5 min, P = 0.003). Major complications (RD-11%, P = 0.302) and 90 -day mortality (RD-2%, P = 0.328) were comparable between laparoscopic MIPD and OPD.Conclusions: This individual patient data meta-analysis of MIPD versus OPD in patients with resectable PDAC suggests that laparoscopic MIPD is non-inferior regarding radicality, lymph node yield, major complications and 90-day mortality and is associated with less blood loss, shorter hospital stay, and longer operation time. The impact on long-term survival and recurrence should be studied in RCTs including robotic MIPD.& COPY; 2023 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Automated summary

This study compared the oncological and surgical outcomes of minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD) in patients with resectable pancreatic ductal adenocarcinoma (PDAC). The results showed that MIPD was non-inferior to OPD in terms of radicality, lymph node yield, major complications, and 90-day mortality. MIPD also had advantages in terms of blood loss, hospital stay, and operation time. These findings suggest that MIPD is a viable alternative to traditional surgery.