The clinical implication of minimally invasive versus open pancreatoduodenectomy for non-pancreatic periampullary cancer - a systematic review and individual patient data meta-analysis

Q: What question does this meta-analysis address?

It assesses the clinical implications of minimally invasive pancreatoduodenectomy versus open pancreatoduodenectomy in patients with non-pancreatic periampullary cancer, including subgroup effects.

Q: How was the evidence collected for the analysis?

A systematic review searched Pubmed, Embase, and Cochrane databases, and individual patient data were required from all included studies comparing MIPD and OPD for NPPC between 01/2015 and 12/2021.

Q: Which outcomes were compared between MIPD and OPD?

The study compared 90-day mortality and major morbidity (Clavien-Dindo 3a–5), and also evaluated postoperative pancreatic fistula, delayed gastric emptying, postpancreatectomy hemorrhage, blood loss, length of hospital stay, and overall survival.

Sep 24, 2026

Uploaded by Fahsai

Minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD) are often compared across pancreatic and periampullary cancers, even though non-pancreatic periampullary cancer (NPPC) comprises biologically and clinically heterogeneous entities. This individual patient data meta-analysis evaluates MIPD versus OPD in NPPC patients, using studies from Pubmed, Embase, and Cochrane, with predefined short- and long-term endpoints.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Periampullary cancer and NPPC heterogeneity

Treatment and rationale for MIPD vs OPD

Langenbeck's Archives of Surgery (2023) 408:311 [https://doi.org/10.1007/s00423-023-03047-4](https://doi.org/10.1007/s00423-023-03047-4) The clinical implication of minimally invasive versus open pancreatoduodenectomy for non‑pancreatic periampullary cancer: a systematic review and individual patient data meta‑analysis Bas A. Uijterwijk1,2 · Meidai Kasai3 · Daniel H. L. Lemmers1,2 · Palanivelu Chinnusamy4 · Jony van Hilst2,5 · Benedetto Ielpo6 · Kongyuan Wei7 · Ki Byung Song8 · Song C. Kim8 · Sjors Klompmaker2 · Jin‑Young Jang9 · Kelly M. Herremans10 · Lapo Bencini11 · Andrea Coratti12 · Michele Mazzola13 · Krishna V. Menon14 · Brian K. P. Goh15 · Renyi Qin16 · Marc G. Besselink2 · Mohammed Abu Hilal1 · for the International Study Group on non‑pancreatic periAmpullary CAncer (ISGACA) Received: 12 April 2023 / Accepted: 3 August 2023 / Published online: 15 August 2023 © The Author(s) 2023 Abstract Background Most studies on minimally invasive pancreatoduodenectomy (MIPD) combine patients with pancreatic and periampullary cancers even though there is substantial heterogeneity between these tumors. Therefore, this study aimed to evaluate the role of MIPD compared to open pancreatoduodenectomy (OPD) in patients with non-pancreatic periampullary cancer (NPPC) . Methods A systematic review of Pubmed, Embase, and Cochrane databases was performed by two independent reviewers to identify studies comparing MIPD and OPD for NPPC (ampullary, distal cholangio, and duodenal adenocarcinoma)(01/2015–12/2021) . Individual patient data were required from all identified studies. Primary outcomes were (90-day) mortality, and major morbidity (Clavien-Dindo 3a-5) . Secondary outcomes were postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), blood-loss, length of hospital stay (LOS), and overall survival (OS) . Results Overall, 16 studies with 1949 patients were included, combining 928 patients with ampullary, 526 with distal cholangio, and 461 with duodenal cancer. In total, 902 (46.3%) patients underwent MIPD, and 1047 (53.7%) patients underwent OPD. The rates of 90-day mortality, major morbidity, POPF, DGE, PPH, blood-loss, and length of hospital stay did not differ between MIPD and OPD. Operation time was 67 min longer in the MIPD group (P = 0.009) . A decrease in DFS for ampullary (HR 2.27, P = 0.019) and distal cholangio (HR 1.84, P = 0.025) cancer, as well as a decrease in OS for distal cholangio (HR 1.71, P = 0.045) and duodenal cancer (HR 4.59, P < 0.001) was found in the MIPD group. Conclusions This individual patient data meta-analysis of MIPD versus OPD in patients with NPPC suggests that MIPD isnot inferior in terms of short-term morbidity and mortality. Several major limitations in long-term data highlight a research gap that should be studied in prospective maintained international registries or randomized studies for ampullary, distal cholangio, and duodenum cancer separately. Protocol registration PROSPERO (CRD42021277495) on the 25th of October 2021. Keywords Minimally invasive surgery · Minimally invasive pancreatoduodenectomy · Ampulla of Vater carcinoma · Duodenal adenocarcinoma · Distal cholangiocarcinoma · Individual patient data meta-analysis Abbreviations AJCC American Joint Committee on Cancer ASA American Society of Anesthesiologists Renyi Qin, Marc G. Besselink, and Mohammed Abu Hilal are shared senior authors. Extended author information available on the last page of the article DFS DGE HR IPDMA IQR MD MIPD NPPC Disease-free survival Delayed gastric emptying Hazard ratio Individual Patient Data Meta-Analysis Inter quartile range Mead difference Minimally invasive pancreatoduodenectomy Non-pancreatic periampullary cancer OPD Open pancreatoduodenectomy OS Overall survival PD Pancreatoduodenectomy PDAC Pancreatic ductal adenocarcinoma POPF Postoperative pancreatic fistula PPH Postpancreatectomy hemorrha

FAQs

What question does this meta-analysis address?

It assesses the clinical implications of minimally invasive pancreatoduodenectomy versus open pancreatoduodenectomy in patients with non-pancreatic periampullary cancer, including subgroup effects.

How was the evidence collected for the analysis?

A systematic review searched Pubmed, Embase, and Cochrane databases, and individual patient data were required from all included studies comparing MIPD and OPD for NPPC between 01/2015 and 12/2021.

Which outcomes were compared between MIPD and OPD?

The study compared 90-day mortality and major morbidity (Clavien-Dindo 3a–5), and also evaluated postoperative pancreatic fistula, delayed gastric emptying, postpancreatectomy hemorrhage, blood loss, length of hospital stay, and overall survival.

Sep 24, 2026

Uploaded by Fahsai