Laparoscopic versus Open Pancreaticoduodenectomy (Whipple Procedure): A Systematic Review

Abstract

Introduction: The Whipple procedure is a complex operation for tumors of the pancreatic head. A minimally invasive (laparoscopic or robotic) approach has been developed, but its safety and efficacy compared to the traditional open approach are debated.

Methods: A systematic review and meta-analysis of comparative studies, including several recent RCTs, was conducted. Studies comparing laparoscopic/robotic to open pancreaticoduodenectomy were included. Primary outcomes were 90-day mortality, major morbidity (including pancreatic fistula), and oncologic outcomes like margin status.

Results: The analysis showed that in high-volume, expert centers, the minimally invasive Whipple was associated with less intraoperative blood loss and shorter hospital stays. There were no significant differences in mortality, overall major morbidity, or rates of clinically relevant pancreatic fistula. Oncologic outcomes were also comparable.

Discussion: The minimally invasive Whipple procedure is technically demanding and has a steep learning curve. However, in experienced hands, it appears to be a safe and feasible alternative to the open approach, offering the typical benefits of minimally invasive surgery.

Conclusion: In high-volume centers, the minimally invasive Whipple procedure is safe and offers comparable oncologic outcomes to the open approach.