title: Duodenopancreatectomy: open or minimally invasive approach?
abstract: BACKGROUND
  Minimally invasive pancreaticoduodenectomy (MIPD) is a complex procedure, offered to selected patients at institutions highly experienced with the procedure. It is still not clear if this approach may enhance patient recovery and reduce postoperative complications comparing to open pancreaticoduodenectomy (OPD), as demonstrated for other abdominal procedures.
  
  
  METHODS
  A systematic literature review was conducted to identify studies comparing MIPD and OPD. Perioperative outcomes (e.g., morbidity and mortality, pancreatic fistula rates, blood loss) constituted the study end points. Metaanalyses were performed using a random-effects model.
  
  
  RESULTS
  For the metaanalysis, 8 studies including 204 patients undergoing MIPD and 419 patients undergoing OPD were considered suitable. The patients in the two groups were similar with respect to age, sex and histological diagnosis, and different with respect to tumor size, rate of pylorus preservation, and type of pancreatic anastomosis. There were no statistically significant differences between MIPD and OPD regarding development of delayed gastric emptying (DGE), pancreatic fistula, wound infection, or rates of reoperation and overall mortality. MIDP resulted in lower post-operative complication rates, less intra-operative blood loss, shorter hospital stays, lower blood transfusion rates, higher numbers of harvested lymph nodes, and improved negative margin status rates. However, MIPD was associated with longer operating times when compared to OPD.
  
  
  CONCLUSIONS
  The MIPD procedure is feasible, safe, and effective in selected patients. MIPD may have some potential advantages over OPD, and should be performed and further developed by use in selected patients at highly experienced medical centers.
authors: Department of Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1037, 00189 Rome, Italy. Electronic address: giuseppe.nigri@uniroma1.it.
authors: Giuseppe
authors: G
authors: Nigri
authors: Department of Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1037, 00189 Rome, Italy.
authors: Niccolò
authors: N
authors: Petrucciani
authors: Department of Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1037, 00189 Rome, Italy.
authors: Marco
authors: M
authors: La Torre
authors: Department of Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1037, 00189 Rome, Italy.
authors: Paolo
authors: P
authors: Magistri
authors: Department of Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1037, 00189 Rome, Italy.
authors: Stefano
authors: S
authors: Valabrega
authors: Department of Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1037, 00189 Rome, Italy.
authors: Paolo
authors: P
authors: Aurello
authors: Department of Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1037, 00189 Rome, Italy.
authors: Giovanni
authors: G
authors: Ramacciato
mesh_terms: D004378:Duodenal Diseases / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome
keywords: Duodenopancreatectomy; Laparoscopic; Minimally invasive; Pancreaticoduodenectomy; Robotic