Minimally invasive versus open distal pancreatectomy for pancreatic cancer: a review of the literature

Background and Objective: Albeit its slow implementation during the past decades, minimally invasive surgery has become the standard approach to benign and premalignant left-sided pancreatic tumors. Two randomized controlled trials reported benefits of minimally invasive distal pancreatectomy (MIDP) over open distal pancreatectomy (ODP). However, its role in the treatment of left-sided pancreatic ductal adenocarcinoma (PDAC) is yet to be established as randomized controlled trials are still lacking. In this review, we aim to provide a comprehensive overview of the currently available evidence on outcomes of MIDP compared to ODP when treating PDAC. Methods: A literature search was performed in PubMed for studies published between January 1994 and January 2022. Besides, international guidelines were screened for eligible studies and the world health organization trial register was screened for ongoing randomized controlled trials on this subject. Only studies published in English peer-reviewed journals were considered eligible. Key Content and Findings: The search strategy identified 30 retrospective comparative studies including over 12,000 patients undergoing either MIDP or ODP for PDAC. Most studies reported comparable radical resection rates and overall survival between the two groups, whereas contradicting results on lymph node yield have been reported. Three retrospective studies reported worse outcomes following extended MIDP compared to extended ODP for pancreatic cancer. Three currently recruiting randomized controlled trials were identified by the trial register search. Conclusions: MIDP for benign and pre-malignant left-sided pancreatic tumors is considered as standard surgical procedure following reported benefits in two randomized controlled trials. For PDAC, available evidence suggests that MIDP is non-inferior to ODP but data from randomized trials are lacking. Currently recruiting randomized trials are expected to answer this question soon. Caution is warranted when performing extended MIDP.