Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7301
Peer-review started: March 26, 2016
First decision: April 14, 2016
Revised: May 4, 2016
Accepted: May 23, 2016
Article in press: May 23, 2016
Published online: August 28, 2016
Pancreatic duct adenocarcinoma is one of the most fatal malignancies, with R0 resection remaining the most important part of treatment of this malignancy. However, pancreatectomy is believed to be one of the most challenging procedures and R0 resection remains the only chance for patients with pancreatic cancer to have a good prognosis. Some surgeons have tried minimally invasive pancreatic surgery, but the short- and long-term outcomes of pancreatic malignancy remain controversial between open and minimally invasive procedures. We collected comparative data about minimally invasive and open pancreatic surgery. The available evidence suggests that minimally invasive pancreaticoduodenectomy (MIPD) is as safe and feasible as open PD (OPD), and shows some benefit, such as less intraoperative blood loss and shorter postoperative hospital stay. Despite the limited evidence for MIPD in pancreatic cancer, most of the available data show that the short-term oncological adequacy is similar between MIPD and OPD. Some surgical techniques, including superior mesenteric artery-first approach and laparoscopic pancreatoduodenectomy with major vein resection, are believed to improve the rate of R0 resection. Laparoscopic distal pancreatectomy is less technically demanding and is accepted in more pancreatic centers. It is technically safe and feasible and has similar short-term oncological prognosis compared with open distal pancreatectomy.
Core tip: Minimally invasive pancreaticoduodenectomy is as safe and feasible as open pancreaticoduodenectomy (OPD) and shows some superiority. The short-term oncological results are similar between laparoscopic pancreaticoduodenectomy (LPD) and OPD. However, in some experienced hands, better prognosis is detected in the LPD group because the patients can receive adjuvant therapy faster because of the benefits of minimal invasiveness. Minimally invasive distal pancreatectomy is a well-established procedure and widely accepted. It is safe, feasible, and has similar short-term oncological results compared with open distal pancreatectomy.