Laparoscopic pancreatoduodenectomy: a narrative review of the feasibility and outcomes

Background and Objective: Pancreatoduodenectomy is the standard procedure for resection of periampullary malignancies. It is a technically complex procedure requiring extensive experience in hepatopancreatobiliary resections and previous data have demonstrated a strong relationship between case volume and outcomes. While laparoscopic approaches have been adopted for other major intra-abdominal resections, pancreatoduodenectomy remains most commonly performed with an open technique due to the technical complexity of the procedure and the steep learning curve. We reviewed the available literature on the outcomes between open (OPD) and laparoscopic (LPD) pancreatoduodenectomy. Methods: A search was conducted in PubMed, Medline, and Cochrane Review databases to identify retrospective and prospective studies comparing outcomes of OPD vs. LPD from 2010 to 2022. We utilized the phrases "minimally invasive", "laparoscopic", "pancreatoduodenectomy", and "Whipple". Key Content and Findings: We identified retrospective and prospective studies evaluating the difference of LPD vs. OPD. To date, four randomized control trials have been conducted to evaluate outcome differences. LPD remains an uncommon procedure, with reports available mainly from high volume centers. LPD requires longer operating time, and patients tend to have shorter lengths of stay, and comparable oncologic outcomes to OPD. The evidence for functional recovery, estimated blood loss, complications, and survival is less consistent across studies. Conclusions: LPD is a feasible procedure; however, the data are largely inconsistent across studies, likely due to the rarity with which the procedure is performed in the surgical community.