Perioperative and short-term oncological outcomes of laparoscopic versus open pancreaticoduodenectomy: an updated systematic review and meta-analysis of randomized controlled trials with GRADE evaluation

BACKGROUND: Surgical resection through pancreatoduodenectomy (PD) represents the only curative option for periampullary and pancreatic head tumors. Recently, laparoscopic pancreatoduodenectomy (LPD) has emerged as a minimally invasive alternative to the open approach (OPD). However, the safety, feasibility, and short-term oncologic adequacy of LPD compared to OPD remain a matter of controversy. This systematic review and meta-analysis aimed to compare perioperative and short-term oncologic outcomes of LPD versus OPD in patients with periampullary and pancreatic head primaries. METHODS: A comprehensive literature search was performed in PubMed, Scopus, and Web of Science databases for RCTs comparing LPD and OPD in adult periampullary tumor patients. Key outcomes analyzed included operative time, blood loss, hospital length of stay, complications, mortality, and lymph node harvest. Risk of bias was assessed using the Cochrane RoB-2 tool, and the certainty of evidence was graded via GRADE. RESULTS: Seven RCTs were included, revealing that LPD is associated with longer operative times (MD~50.90 min) but significantly reduced blood loss (MD-88.83 mL), shorter hospital stays (MD-1.33 days), and fewer transfusions (RR 0.75). No significant differences were observed in 90-day mortality, overall or severe complications, lymph node retrieval, or R0 resection rates. The GRADE rating was high for clinically relevant gastric emptying, and moderate or low certainty for most other outcomes. CONCLUSION: LPD provides statistically significant perioperative advantages without compromising oncological outcomes, suggesting it is a safe and effective alternative to OPD in experienced centers.