Abstract
Pancreatic head cancer still represents an insurmountable barrier for patients and pancreatic surgeons. Pancreaticoduodenectomy (PD) continues to be the operative standard of care and potentially curative procedure for pancreatic head cancer. Despite the rapid development of minimally invasive techniques, whether the efficacy of minimally invasive pancreaticoduodenectomy (MIPD) is noninferior or superior to open pancreaticoduodenectomy (OPD) remains unclear. In this review, we summarized the history of OPD and MIPD and the latest staging and classification information for pancreatic head cancer as well as the proposed recommendations for MIPD indications for patients with pancreatic head cancer. By reviewing the MIPD- vs. OPD-related literature, we found that MIPD shows noninferiority or superiority to OPD in terms of safety, feasibility, enhanced recovery after surgery (ERAS) and several short-term and long-term outcomes. In addition, we analyzed and summarized the different MIPD outcomes in the USA, Europe and China. Certain debates over MIPD have continued, however, selection bias, the large number of low-volume centers, the steep MIPD learning curve, high conversion rate and administration of neoadjuvant therapy may limit the application of MIPD for pancreatic head cancer.
Highlights
Pancreatic cancer is a highly lethal human disease with a 5year overall survival rate of 8% [1,2]
Whether minimally invasive pancreaticoduodenectomy (MIPD) is superior to open pancreaticoduodenectomy (OPD) for pancreatic head cancer in terms of safety, feasibility, short-term or long-term outcomes remains controversial
Based on the PD development history, staging and classification, as well as the European recommendations, we provided recommendations of indications for MIPD for pancreatic head cancer
Summary
Pancreatic cancer is a highly lethal human disease with a 5year overall survival rate of 8% [1,2]. During the development of OPD, many surgeons have tried many other surgical procedures, including pyloruspreserving pancreaticoduodenectomy (PPPD), extended pancreaticoduodenectomy (EPD), regional pancreatectomy (RP), and total pancreatectomy (TP) It is still controversial whether PPPD will influence the short-term (R0 resection) and long-term (overall survival) oncological outcomes of patients with pancreatic head cancer. For patients with borderline resectable and locally advanced pancreatic head cancer, neoadjuvant chemoradiotherapy should be used for tumor downstaging and an increase in resectability; OPD should be the best choice for those patients. When MIPD is performed by surgeons at the early phase of the learning curve or at low-volume centers (number of MIPD
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