Intraoperative and Postoperative Outcomes of Minimally Invasive Versus Open Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis.

Background: This systematic review and meta-analysis compared the intraoperative and postoperative outcomes of minimally invasive versus open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC), which is a highly aggressive tumor with a high mortality rate. Surgical resection remains the only potentially curative treatment. Minimally invasive distal pancreatectomy (MIDP), including laparoscopic and robotic approaches, has gained popularity, although the evidence of its efficacy is limited.

Materials And Methods: PubMed, Scopus, and Web of Science databases were searched for studies that compared MIDP and ODP. Randomized clinical trials (RCTs) and observational studies were included. Risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CI) were used to analyze the outcomes. Heterogeneity was assessed using the I test, and statistical significance was set at p < 0.05. Analyses were conducted using the RStudio version 4.4.1.

Results: A total of 20 studies with 9339 patients were included, of which 2219 (23.76%) underwent MIDP and 7120 (76.24%) ODP. MIDP was associated with reduced hospital stay (MD - 1.99; p < 0.000001), infections (RR 0.58; p = 0.001855), delayed gastric emptying (RR 0.48; p = 0.003677), blood loss (MD - 55.55; p = 0.000005), transfusions (RR 0.36; p < 0.000001), and 90-day mortality (RR 0.43; p = 0.001092). Other outcomes, including pancreatic fistula, complications according to the Clavien-Dindo classification, operative time, and reoperation, showed insignificant differences.

Conclusions: MIDP for PDAC offers better clinical outcomes than ODP, including reduced infections and transfusions. Further RCTs are needed to validate these findings and update the guidelines.