Exploring the landscape of minimally invasive pancreatic surgery: Progress, challenges, and future directions

Table 1 Minimally invasive vs open distal pancreatectomy published randomized clinical trials

	de Rooij T 2019 (LEOPARD), Lps vs Open[11]			Björnsson 2020 (LAPOP), Lps vs Open[14]			Korrel 2023 (DIPLOMA), Lps/Robotic vs Open[23]
Enrollment period	2015-2017			2015-2019			2018-2021
	MI	O	P value	MI	O	P value	MI	O	P value
n	51	57		29	29		114	110
OT (minute)	217	179	0.005	120	120	NS	240	209	0.01
EBL (mL)	150	400	0.001	50	100	0.018	200	200	0.06
CR-POPF (%)	39	23	0.07	31	37	NS	21	17	NS
DGE (%)	6	19	0.04	3	17	NS	2	3	NS
PPH (%)	4	4	NS	3	0	NS	2	3	NS
SSI (%)	4	5	NS				5	5	NS
Reintervention (%)	2	5	NS				17	17	NS
Severe morbidity (Clavien-Dindo ≥ 3) (%)	25	38	NS	14	27	NS	19	20	NS
LOS (days)	6	8	0.004	6	8	0.008	7	7	NS
Readmission (%)	29	25	NS	4	6	NS	22	21	NS
90-day mortality (%)	0	2	NS	0	1	NS	1	2	NS
R0 (%)							83	76		0.039
N harvested Lymph nodes (n)							22	23		NS

OT: Operative time; EBL: Estimated blood loss; CR-POPF: Clinically relevant-post-operative pancreatic fistula; DGE: Delayed gastric emptying; PPH: Post-pancreatectomy hemorrhage; SSI: Surgical site infection; LOS: Length of stay.

Table 2 Minimally invasive vs open pancreaticoduodenectomy published randomized clinical trials

	Palanivelu 2017 (PLOT), Lps vs Open[50]			Poves 2018 (PADULAP), Lps vs Open[51]			Van Hilst 2019 (LEOPARD 2), Lps vs Open[52]			Wang 2021, Lps vs Open[53]			Klotz 2024 (EUROPA), Robotic vs Open[62]			Liu 2024, Robotic vs Open[63]
Enrollment period	2013-2015			2013-2017			2016-2017			2018-2019			2020-2022			2022
	MI	O	p	MI	O	p	MI	O	p	MI	O	p	MI	O	p	MI	O	p
n	32	32		34	32		50	59		297	297		29	33		81	80
OT (minute)	359	320	0.041	486	365	0.001	410	274	0.001	325	300	0.001	431	367	0.021	245	298	0.001
EBL (mL)	250	401	0.001				300	450	NS	200	300	0.001	742	814	NS	75	150	0.001
CR-POPF (%)	6	12	NS	13	28	NS	28	24	NS	10	11	NS	38	21	NS	14	13	NS
Bile leakage (%)	9	6	NS	3	10	NS	12	10	NS	13	14	NS	17	9	NS	16	23	NS
Gastro/duodenojejunal fistula (%)				0	0	NS	4	0	NS
Chyle leak (%)							4	14	0.09				7	3	NS
DGE (%)	16	22	NS	9	24	NS	34	20	NS	30	32	NS	34	6	0.005	25	33	NS
PPH (%)	9	12	NS	9	21	NS	10	14	NS	13	11	NS	14	3	NS	14	19	NS
SSI (%)	12	25	0.015				4	14	0.09				10	10	NS	10	11	NS
Reintervention (%)	3	3	NS	3	17	0.06	12	6	NS	3	4	NS	14	15	NS	3	4	NS
Severe morbidity (Clavien-Dindo ≥ 3) (%)	9	12	NS	16	38	0.048	50	39	NS	29	23	NS				22	24	NS
LOS, days	7	13	0.001	13.5	17	0.024	11	10	NS	15	16	0.02	17	13	NS	11	13.5	0.029
Readmission (%)	6	9	NS	22	14	NS	16	20	NS	3	2	NS	17	16	NS	7	6	NS
90-day mortality (%)	3	3	NS	0	2	NS	10	2	NS	2	2	NS	0	9		1	1	NS
R0 (%)	97	94	NS	60	52	NS	82	76	NS	98	97	NS	80	100	NS	96	96	NS
N harvested Lymph nodes (n)	18	17	NS	15	21	NS	11	11	NS	12	13	NS	29	26	NS	13	13	NS

OT: Operative time; EBL: Estimated blood loss; CR-POPF: Clinically relevant-post-operative pancreatic fistula; DGE: Delayed gastric emptying; PPH: Post-pancreatectomy hemorrhage; SSI: Surgical site infection; LOS: Length of stay.