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Minimally Invasive vs. Open Pancreaticoduodenectomy for Distal Cholangiocarcinoma: A Systematic Review and Meta-analysis.

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Τίτλος: Minimally Invasive vs. Open Pancreaticoduodenectomy for Distal Cholangiocarcinoma: A Systematic Review and Meta-analysis.
Συγγραφείς: Bakht D; King Edward Medical University, Lahore, Punjab, Pakistan., Khan AA; King Edward Medical University, Lahore, Punjab, Pakistan., Hashmi H; Bakhtawar Amin Medical and Dental College, Multan, Pakistan., Amir M; King Edward Medical University, Lahore, Punjab, Pakistan., Ur Rehman U; King Edward Medical University, Lahore, Pakistan., Mahmood A; Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College, Lahore, Pakistan., Naeem M; King Edward Medical University, Lahore, Pakistan., Raza MA; CMH Institute of Medical Sciences, Bahawalpur, Pakistan., Naeem F; King Edward Medical University, Lahore, Pakistan., Sarfraz A; King Edward Medical University, Lahore, Pakistan., Ismail S; Akhtar Saeed Medical and Dental College, Lahore, Pakistan., Tanvir K; King Edward Medical University, Lahore, Punjab, Pakistan., Bahadri MMS; Khyber Medical University, Peshawar, KpK, Pakistan., Hasan AH; Oli Health Magazine Organization, Research and Education, Kigali, Rwanda. abdulhaseebhasan.md@gmail.com., Saleem F; Faisalabad Medical University, Faisalabad, Punjab, Pakistan., Bokhari SFH; King Edward Medical University, Lahore, Punjab, Pakistan., Hassan A; King Edward Medical University, Lahore, Punjab, Pakistan.
Πηγή: Journal of gastrointestinal cancer [J Gastrointest Cancer] 2026 Jul 25; Vol. 57 (1). Date of Electronic Publication: 2026 Jul 25.
Τύπος έκδοσης: Journal Article; Systematic Review; Meta-Analysis; Comparative Study; Review
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Springer Country of Publication: United States NLM ID: 101479627 Publication Model: Electronic Cited Medium: Internet ISSN: 1941-6636 (Electronic) NLM ISO Abbreviation: J Gastrointest Cancer Subsets: MEDLINE
Imprint Name(s): Publication: 2010- : New York : Springer
Original Publication: New York, NY : Humana Press
Ιατρικοί όροι (MeSH): Pancreaticoduodenectomy*/methods , Pancreaticoduodenectomy*/adverse effects , Cholangiocarcinoma*/surgery , Cholangiocarcinoma*/mortality , Cholangiocarcinoma*/pathology , Bile Duct Neoplasms*/surgery , Bile Duct Neoplasms*/mortality , Bile Duct Neoplasms*/pathology , Laparoscopy*/methods , Laparoscopy*/adverse effects , Minimally Invasive Surgical Procedures*/methods , Minimally Invasive Surgical Procedures*/adverse effects , Robotic Surgical Procedures*/methods , Robotic Surgical Procedures*/adverse effects, Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Humans ; Treatment Outcome
Περίληψη: Background: Distal cholangiocarcinoma (dCCA) is a rare but aggressive biliary malignancy arising from the distal bile duct with significant clinical burden. Pancreaticoduodenectomy (minimally invasive or open) remains the only potentially curative treatment for dCCA. However, the comparative safety and oncologic adequacy of minimally invasive versus open pancreaticoduodenectomy remains unclear, creating an evidence gap that this systematic review addresses.
Objective: This systematic review and meta-analysis aimed to compare perioperative outcomes and oncologic effectiveness of MIPD versus OPD in patients undergoing surgery for distal cholangiocarcinoma.
Methods: A systematic literature search of PubMed, Embase, Cochrane Library, and Science Direct was conducted through April 2025 in accordance with PRISMA guidelines. Eligible studies included cohort studies, randomized controlled trials, and case-control studies comparing MIPD (laparoscopic or robotic) with OPD in dCCA. Data regarding operative parameters, oncologic outcomes, perioperative morbidity, and mortality were extracted. Meta-analysis was performed using Review Manager 5.4, applying fixed- or random-effects models based on heterogeneity.
Results: Seven retrospective cohort studies comprising 1,803 patients (775 MIPD vs. 1,028 OPD) were included. MIPD was associated with significantly lower blood loss (WMD - 100.86 mL, 95% CI - 107.27 to - 94.46; I² = 90%; p < 0.001) and shorter hospital stay (WMD - 2.46 days, 95% CI - 4.08 to - 0.84; I² = 89%; p = 0.003), but longer operative time (WMD 52.60 min, 95% CI 16.82 to 88.39; I² = 99%; p = 0.004). There was no significant difference in major complications (Clavien-Dindo ≥ III) (OR 0.97, 95% CI 0.74-1.28; p = 0.85) or postoperative mortality (OR 0.46, 95% CI 0.16-1.33; I² = 56%; p = 0.15) between groups. Importantly, long-term oncologic outcomes were also comparable between groups, with no significant differences observed in overall survival (HR 0.90, 95% CI 0.77-1.05; p = 0.19) or disease-free survival (HR 0.98, 95% CI 0.83-1.16; p = 0.83). No survival disadvantage was demonstrated for MIPD compared with OPD.
Conclusion: MIPD appears to be a safe and feasible alternative to OPD for selected patients with distal cholangiocarcinoma, offering perioperative benefits without compromising oncologic outcomes. Importantly, available evidence also demonstrates no compromise in long-term oncologic outcomes, with comparable overall and disease-free survival between MIPD and OPD. However, given the rarity of dCCA, stand-alone randomized controlled trials are unlikely to be feasible. Future evidence should therefore focus on stratifying dCCA patients within ongoing or future multicenter trials of minimally invasive pancreaticoduodenectomy for periampullary malignancies, as well as prospective international registry-based studies with mandatory reporting of histological subtypes to generate high-quality, generalizable evidence.
(© 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Competing Interests: Declarations. Disclosure: During the manuscript preparation process, the authors employed AI-assisted tools ( ChatGPT − 4 and DeepSeek ) for linguistic refinement and structural organization. The authors assume full responsibility for accuracy and integrity of final content. Competing interests: The authors declare no competing interests.
References: Gorji L, Beal EW. Surgical Treatment of Distal Cholangiocarcinoma. Curr Oncol Tor Ont. 2022;29(9):6674–87. doi:10.3390/curroncol29090524 PubMed PMID: 36135093; PubMed Central PMCID: PMC9498206. (PMID: 10.3390/curroncol29090524)
Veillette G, Castillo CFdel. Distal Biliary Malignancy. Surg Clin North Am. 2008;88(6):1429–47. https://doi.org/10.1016/j.suc.2008.07.003 . (PMID: 10.1016/j.suc.2008.07.00318992603)
Forner A, Vidili G, Rengo M, Bujanda L, Ponz-Sarvisé M, Lamarca A. Clinical presentation, diagnosis and staging of cholangiocarcinoma. Liver Int. 2019;39(S1):98–107. https://doi.org/10.1111/liv.14086 . (PMID: 10.1111/liv.1408630831002)
Skalicky P, Urban O, Ehrmann J, Svebisova H, Klos D, Tesarikova J, et al. The short- and long-term outcomes of pancreaticoduodenectomy for distal cholangiocarcinoma. Biomed Pap. 2022;166(4):386–92. https://doi.org/10.5507/bp.2021.043 . (PMID: 10.5507/bp.2021.043)
Wang HX, Wang ZY, Lang R, He Q, Lyu SC. Micro-invasive pancreaticoduodenectomy will be a promising treatment option for distal cholangiocarcinoma. Hepatobiliary Surg Nutr. 2024;13(5):841–4. https://doi.org/10.21037/hbsn-24-331 . (PMID: 10.21037/hbsn-24-3313950772311534782)
Conlon KC, Klimstra DS, Brennan MF. Long-Term Survival After Curative Resection for Pancreatic Ductal Adenocarcinoma: Clinicopathologic Analysis of 5-Year Survivors. Ann Surg. 1996;223(3):273–9. https://doi.org/10.1097/00000658-199603000-00007 . (PMID: 10.1097/00000658-199603000-0000786049071235115)
Carpelan-Holmstrom M. Does anyone survive pancreatic ductal adenocarcinoma? A nationwide study re-evaluating the data of the Finnish Cancer Registry. Gut. 2005;54(3):385–7. https://doi.org/10.1136/gut.2004.047191 . (PMID: 10.1136/gut.2004.047191157109871774412)
Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Büchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg. 2004;91(5):586–94. https://doi.org/10.1002/bjs.4484 . (PMID: 10.1002/bjs.448415122610)
Byrling J, Andersson R, Sasor A, Lindell G, Ansari D, Nilsson J, et al. Outcome and evaluation of prognostic factors after pancreaticoduodenectomy for distal cholangiocarcinoma. Ann Gastroenterol. 2017;30(5):571–7. https://doi.org/10.20524/aog.2017.0169 . PubMed PMID: 28845114; PubMed Central PMCID: PMC5566779. (PMID: 10.20524/aog.2017.0169288451145566779)
Are C, Dhir M, Ravipati L. History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers. HPB. 2011;13(6):377–84. https://doi.org/10.1111/j.1477-2574.2011.00305.x . (PMID: 10.1111/j.1477-2574.2011.00305.x216093693103093)
Dai R, Turley RS, Blazer DG. Contemporary review of minimally invasive pancreaticoduodenectomy. World J Gastrointest Surg. 2016;8(12):784–91. https://doi.org/10.4240/wjgs.v8 . i12.784 PubMed PMID: 28070234; PubMed Central PMCID: PMC5183922. (PMID: 10.4240/wjgs.v8280702345183922)
de Graaf N, Emmen AMLH, Ramera M, Björnsson B, Boggi U, Bruna CL, et al. Minimally invasive versus open pancreatoduodenectomy for pancreatic and peri-ampullary neoplasm (DIPLOMA-2): study protocol for an international multicenter patient-blinded randomized controlled trial. Trials. 2023;24(1):665. https://doi.org/10.1186/s13063-023-07657-7 . PubMed PMID: 37828593; PubMed Central PMCID: PMC10571285. (PMID: 10.1186/s13063-023-07657-73782859310571285)
Domene S, Quiroz Flores M, Fulginiti D, Thomas Garcia KD, Abera Woldehana N, Nunez Jimenez KM, et al. Comparative outcomes of minimally invasive versus open pancreatoduodenectomy in distal cholangiocarcinoma: A systematic review and meta-analysis. Cureus. 2024. https://doi.org/10.7759/cureus.59404 .
Addeo P. Devil’s advocate: is there any real advantage of mini-invasive pancreaticoduodenectomy versus open pancreaticoduodenectomy? Laparosc Surg. 2021;5:21–21. https://doi.org/10.21037/ls-20-60 . (PMID: 10.21037/ls-20-60)
Yumoto S, Hayashi H, Mima K, Ogawa D, Itoyama R, Kitano Y, et al. Effects of Minimally Invasive Versus Open Pancreatoduodenectomy on Short-Term Surgical Outcomes and Postoperative Nutritional and Immunological Statuses: A Single-Institution Propensity Score-Matched Study. Ann Surg Open Perspect Surg Hist Educ Clin Approaches. 2024;5(3):e487. https://doi.org/10.1097/AS9 . 0000000000000487 PubMed PMID: 39310352; PubMed Central PMCID: PMC11415100. (PMID: 10.1097/AS9)
Cos H, LeCompte MT, Srinivasa S, Zarate Rodriguez J, Woolsey CA, Williams G, et al. Improved outcomes with minimally invasive pancreaticoduodenectomy in patients with dilated pancreatic ducts: a prospective study. Surg Endosc. 2022;36(5):3100–9. https://doi.org/10.1007/s00464-021-08611-x . PubMed PMID: 34235587; PubMed Central PMCID: PMC8262764. (PMID: 10.1007/s00464-021-08611-x34235587)
Karunakaran M, Marshall-Webb M, Ullah S, Barreto SG. Impact of Unplanned Intra‐Operative Conversions on Outcomes in Minimally Invasive Pancreatoduodenectomy. World J Surg. 2023;47(10):2507–18. https://doi.org/10.1007/s00268-023-07114-1 . (PMID: 10.1007/s00268-023-07114-13743646910473988)
Zhao Z, Yin Z, Hang Z, Ji G, Feng Q, Zhao Q. A systemic review and an updated meta-analysis: minimally invasive vs open pancreaticoduodenectomy. Sci Rep. 2017;7(1):2220. https://doi.org/10.1038/s41598-017-02488-4 . (PMID: 10.1038/s41598-017-02488-4285335365440387)
Yin SM, Liu YW, Liu YY, Yong CC, Wang CC, Li WF, et al. Short-term outcomes after minimally invasive versus open pancreaticoduodenectomy in elderly patients: a propensity score-matched analysis. BMC Surg. 2021;21(1):60. https://doi.org/10.1186/s12893-021-01052-2 . (PMID: 10.1186/s12893-021-01052-2334947347836577)
Zenoni SA, Arnoletti JP, De La Fuente SG. Recent Developments in Surgery: Minimally Invasive Approaches for Patients Requiring Pancreaticoduodenectomy. JAMA Surg. 2013;148(12):1154. https://doi.org/10.1001/jamasurg.2013.366 . (PMID: 10.1001/jamasurg.2013.36624154790)
Nigri G, Petrucciani N, La Torre M, Magistri P, Valabrega S, Aurello P, et al. Duodenopancreatectomy: Open or minimally invasive approach? Surgeon. 2014;12(4):227–34. https://doi.org/10.1016/j.surge.2014.01.006 . (PMID: 10.1016/j.surge.2014.01.00624525404)
Qin H, Qiu J, Zhao Y, Pan G, Zeng Y. Does Minimally-Invasive Pancreaticoduodenectomy Have Advantages over Its Open Method? A Meta-Analysis of Retrospective Studies. Algül H, editor. PLoS One. 2014;9(8):e104274. https://doi.org/10.1371/journal.pone.0104274 .
Kendrick ML, Van Hilst J, Boggi U, De Rooij T, Walsh RM, Zeh HJ, et al. Minimally invasive pancreatoduodenectomy. HPB. 2017;19(3):215–24. https://doi.org/10.1016/j.hpb.2017.01.023 . (PMID: 10.1016/j.hpb.2017.01.02328317658)
Yan Y, Hua Y, Chang C, Zhu X, Sha Y, Wang B. Laparoscopic versus open pancreaticoduodenectomy for pancreatic and periampullary tumor: A meta-analysis of randomized controlled trials and non-randomized comparative studies. Front Oncol. 2023;12:1093395. https://doi.org/10.3389/fonc.2022.1093395 . (PMID: 10.3389/fonc.2022.1093395367614169905842)
Pfister M, Probst P, Müller PC, Antony P, Klotz R, Kalkum E, et al. Minimally invasive versus open pancreatic surgery: meta-analysis of randomized clinical trials. BJS Open. 2023;7(2):zrad007. https://doi.org/10.1093/bjsopen/zrad007 . (PMID: 10.1093/bjsopen/zrad0073696746910040400)
Kim SH, Lee B, Hwang HK, Lee JS, Han H, Lee WJ, et al. Comparison of postoperative complications and long-term oncological outcomes in minimally invasive versus open pancreatoduodenectomy for distal cholangiocarcinoma: A propensity score‐matched analysis. J Hepato-Biliary-Pancreat Sci. 2022;29(3):329–37. https://doi.org/10.1002/jhbp.1067 . (PMID: 10.1002/jhbp.1067)
Shin DH, Choi M, Rho SY, Hong SS, Kim SH, Hwang HK, et al. Minimally invasive pancreatoduodenectomy with combined venous vascular resection: A comparative analysis with open approach. Ann Hepato-Biliary-Pancreat Surg. 2024;28(4):500–7. https://doi.org/10.14701/ahbps.24-082 . (PMID: 10.14701/ahbps.24-082)
Yang E, Chong Y, Wang Z, Koh YX, Lim KI, Goh P. Minimally-invasive versus open pancreatoduodenectomies with vascular resection: A 1 1 propensity-matched comparison study. J Minimal Access Surg. 2022;18(3):420–5. https://doi.org/10.4103/jmas.jmas&#95;201&#95;21 . (PMID: 10.4103/jmas.jmas_201_21)
Addeo P. Minimally invasive pancreaticoduodenectomy with venous resection: results of a systematic review. Mini-Invasive Surg. 2020. https://doi.org/10.20517/2574-1225.2020.47 .
Torphy RJ, Friedman C, Halpern A, Chapman BC, Ahrendt SS, McCarter MM, et al. Comparing Short-term and Oncologic Outcomes of Minimally Invasive Versus Open Pancreaticoduodenectomy Across Low and High Volume Centers. Ann Surg. 2019;270(6):1147–55. https://doi.org/10.1097/SLA.0000000000002810 . (PMID: 10.1097/SLA.000000000000281029771723)
Wang HX, Wang ZY, Lang R, He Q, Lyu SC. Micro-invasive pancreaticoduodenectomy will be a promising treatment option for distal cholangiocarcinoma. Hepatobiliary Surg Nutr. 2024;13(5):841–4. https://doi.org/10.21037/hbsn-24-331 . PubMed PMID: 39507723; PubMed Central PMCID: PMC11534782. (PMID: 10.21037/hbsn-24-3313950772311534782)
Da Dong X, Felsenreich DM, Gogna S, Rojas A, Zhang E, Dong M, et al. Robotic pancreaticoduodenectomy provides better histopathological outcomes as compared to its open counterpart: a meta-analysis. Sci Rep. 2021;11(1):3774. https://doi.org/10.1038/s41598-021-83391-x . PubMed PMID: 33580139; PubMed Central PMCID: PMC7881190. (PMID: 10.1038/s41598-021-83391-x335801397881190)
Contributed Indexing: Keywords: Distal cholangiocarcinoma; Minimally invasive pancreaticoduodenectomy; Open pancreaticoduodenectomy
Entry Date(s): Date Created: 20260725 Date Completed: 20260725 Latest Revision: 20260725
Update Code: 20260726
DOI: 10.1007/s12029-026-01541-8
PMID: 42501209
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1941-6636
DOI:10.1007/s12029-026-01541-8