Comparative outcomes of laparoscopic vs open pancreaticoduodenectomy in early-stage pancreatic cancer

Abstract

BACKGROUND

Pancreaticoduodenectomy (PD) represents the standard surgical approach for resectable pancreatic ductal adenocarcinoma (PDAC); however, its high morbidity has prompted the exploration of minimally invasive alternatives. While laparoscopic PD (LPD) has demonstrated promise, evidence comparing LPD and open PD (OPD) in early-stage PDAC remains limited.

AIM

To compare the perioperative and oncologic outcomes of LPD and OPD in patients with early-stage PDAC.

METHODS

This retrospective propensity-matched analysis included 100 patients with stage I-II PDAC who underwent curative PD between January 2022 and December 2024. Patients were matched 1:1 for age, sex, body mass index, American Society of Anesthesiologists score, and tumor stage. Perioperative outcomes assessed included operative time, blood loss, transfusion rate, hospital stay, complications (overall, severe, pancreatic fistula, delayed gastric emptying, wound infection, intra-abdominal abscess, bile leak, pulmonary complications, and sepsis), and enhanced recovery after surgery metrics (time to mobilization, oral intake, and pain scores). Oncologic outcomes included lymph node yield, R0 resection rate, recurrence-free survival, and overall survival (OS).

RESULTS

Compared with OPD, LPD was associated with reduced intraoperative blood loss [median 170 mL (interquartile range: 130-220 mL) vs median 340 mL (interquartile range: 280-410 mL); P < 0.001], lower transfusion rates (8% vs 22%; P = 0.03), and shorter hospital stays (12 ± 3 days vs 15 ± 4 days; P = 0.002), although operative times were longer (320 ± 45 minutes vs 285 ± 40 minutes; P < 0.001). Overall complication rates (42% vs 50%), severe complications (16% vs 22%), pancreatic fistula (12% vs 16%), delayed gastric emptying (10% vs 14%), and specific complications (wound infection: 6% vs 14%; intra-abdominal abscess: 4% vs 6%; bile leak: 2% vs 4%; pulmonary complications: 8% vs 12%; sepsis: 4% vs 6%) were comparable between the groups (all P > 0.05). enhanced recovery after surgery metrics favored LPD, with earlier mobilization (8.5 ± 3.2 hours vs 12.4 ± 4.1 hours; P = 0.001), earlier oral intake (1.2 ± 0.5 days vs 2.1 ± 0.8 days; P < 0.001), and lower pain scores (3.5 ± 1.2 vs 4.8 ± 1.5; P < 0.001). Oncologic outcomes, including lymph node yield, R0 resection rates, recurrence-free survival, and OS, were similar, with a median OS of 22 months for LPD vs 20 months for OPD (log-rank P = 0.65).

CONCLUSION

LPD offers perioperative benefits, including reduced blood loss, fewer transfusions, shorter hospital stays, and improved recovery metrics, without compromising oncologic outcomes in early-stage PDAC. These findings support its selective use in high-volume centers with experienced surgeons, promoting faster recovery while maintaining long-term efficacy.

Keywords: Pancreatic ductal adenocarcinoma; Laparoscopic pancreaticoduodenectomy; Open pancreaticoduodenectomy; Minimally invasive surgery; Oncologic outcomes

Core Tip: Pancreaticoduodenectomy (PD) remains the cornerstone treatment for resectable pancreatic ductal adenocarcinoma, but its morbidity is substantial. Minimally invasive techniques, particularly laparoscopic PD (LPD), have emerged as alternatives to open surgery. However, evidence in early-stage pancreatic cancer is limited. In this propensity-matched analysis from a high-volume center, LPD demonstrated reduced blood loss (by 170 mL), fewer transfusions, and a shorter hospital stay (by 3 days), while showing comparable complication rates, R0 resection rates, lymph node yield, and survival outcomes to open PD. These findings suggest that LPD may be a safe and effective option in carefully selected early-stage patients, supporting its integration into surgical practice in experienced centers.