Academic Journal
Minimally Invasive vs. Open Pancreaticoduodenectomy for Distal Cholangiocarcinoma: A Systematic Review and Meta-analysis.
| Title: | Minimally Invasive vs. Open Pancreaticoduodenectomy for Distal Cholangiocarcinoma: A Systematic Review and Meta-analysis. |
|---|---|
| Authors: | 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. |
| Source: | Journal of gastrointestinal cancer [J Gastrointest Cancer] 2026 Jul 25; Vol. 57 (1). Date of Electronic Publication: 2026 Jul 25. |
| Publication Type: | Journal Article; Systematic Review; Meta-Analysis; Comparative Study |
| Language: | English |
| Journal Info: | 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 |
| MeSH Terms: | 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 |
| Abstract: | 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: | Surgeon. 2014 Aug;12(4):227-34. (PMID: 24525404) Ann Surg. 1996 Mar;223(3):273-9. (PMID: 8604907) Ann Surg. 2019 Dec;270(6):1147-1155. (PMID: 29771723) HPB (Oxford). 2011 Jun;13(6):377-84. (PMID: 21609369) BJS Open. 2023 Mar 7;7(2):. (PMID: 36967469) JAMA Surg. 2013 Dec;148(12):1154-7. (PMID: 24154790) World J Gastrointest Surg. 2016 Dec 27;8(12):784-791. (PMID: 28070234) HPB (Oxford). 2017 Mar;19(3):215-224. (PMID: 28317658) World J Surg. 2023 Oct;47(10):2507-2518. (PMID: 37436469) Gut. 2005 Mar;54(3):385-7. (PMID: 15710987) Sci Rep. 2017 May 22;7(1):2220. (PMID: 28533536) Br J Surg. 2004 May;91(5):586-94. (PMID: 15122610) Surg Endosc. 2022 May;36(5):3100-3109. (PMID: 34235587) Ann Gastroenterol. 2017;30(5):571-577. (PMID: 28845114) Sci Rep. 2021 Feb 12;11(1):3774. (PMID: 33580139) Front Oncol. 2023 Jan 25;12:1093395. (PMID: 36761416) Trials. 2023 Oct 12;24(1):665. (PMID: 37828593) Surg Clin North Am. 2008 Dec;88(6):1429-47, xi. (PMID: 18992603) BMC Surg. 2021 Jan 25;21(1):60. (PMID: 33494734) Liver Int. 2019 May;39 Suppl 1:98-107. (PMID: 30831002) Hepatobiliary Surg Nutr. 2024 Oct 1;13(5):841-844. (PMID: 39507723) |
| Contributed Indexing: | Keywords: Distal cholangiocarcinoma; Minimally invasive pancreaticoduodenectomy; Open pancreaticoduodenectomy |
| Entry Date(s): | Date Created: 20260725 Date Completed: 20260725 Latest Revision: 20261010 |
| Update Code: | 20261010 |
| DOI: | 10.1007/s12029-026-01541-8 |
| PMID: | 42501209 |
| Database: | MEDLINE |
| ISSN: | 1941-6636 |
|---|---|
| DOI: | 10.1007/s12029-026-01541-8 |