Laparoscopic vs Open Pancreaticoduodenectomy—an Updated Meta-Analysis of Randomized Control Trials

There is ongoing debate regarding the usefulness of laparoscopic pancreaticoduodenectomy. This study aimed to analyze all the randomized control trials published including the most recent one. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I². The random-effects models were used to summarize the relative risks, odds ratios, and mean differences as appropriate. Four RCTs were included consisting of 818 patients. Four hundred eleven patients were in the laparoscopic group and 407 in the open pancreaticoduodenectomy group. Weighted baseline patient characteristics were similar except more patients with pancreatic adenocarcinoma and more males were there in the open pancreaticoduodenectomy group. There was no difference in-hospital stay, 90-day complication rate, 90-day mortality, R1 resection, postoperative pancreatic fistula, delayed gastric emptying, postpancreatectomy hemorrhage, and bile leak between the two groups. Operative time was more in the laparoscopic group. Blood loss [mean difference − 132.12 ml (− 172.60, − 91.65)] and surgical site infection [risk ratio 0.41 (0.17–1.0)] were significantly lesser in laparoscopic group. There was no benefit in-hospital stay or clinical outcomes after laparoscopic pancreaticoduodenectomy. Blood loss and surgical site infection were lesser in laparoscopic pancreaticoduodenectomy.