Effects of Minimally Invasive Versus Open Pancreatoduodenectomy on Short-Term Surgical Outcomes and Postoperative Nutritional and Immunological Statuses: A Single-Institution Propensity Score-Matched Study.

OBJECTIVE

To evaluate the feasibility and clinical impact of minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) on postoperative nutritional and immunological indices.

BACKGROUND

The surgical advantages of MIPD over OPD are controversial, and the postoperative nutritional and immunological statuses are unknown.

METHODS

In total, 306 patients who underwent MIPD (n = 120) or OPD (n = 186) for periampullary tumors from April 2016 to February 2024 were analyzed. Surgical outcomes and postoperative nutritional and immunological indices (albumin, prognostic nutritional index [PNI], neutrophil-to-lymphocyte ratio [NLR], and platelet-to-lymphocyte ratio [PLR]) were examined by 1:1 propensity score matching (PSM) with well-matched background characteristics.

RESULTS

PSM resulted in 2 balanced groups of 99 patients each. Compared with OPD, MIPD was significantly associated with less estimated blood loss ( < 0.0001), fewer intraoperative blood transfusions ( = 0.001), longer operative time, shorter postoperative hospital stay ( < 0.0001), fewer postoperative complications ( = 0.001) (especially clinically relevant postoperative pancreatic fistula [ = 0.018]), and a higher rate of textbook outcome achievement (70.7% vs 48.5%, = 0.001). The number of dissected lymph nodes and the R0 resection rate did not differ between the 2 groups. In elective cases with textbook outcome achievement, the change rates of albumin, PNI, NLR, and PLR from before to after surgery were equivalent in both groups.

CONCLUSIONS

MIPD has several surgical advantages (excluding a prolonged operative time), and it enhances the achievement of textbook outcomes over OPD. However, the postoperative nutritional and immunological statuses are equivalent for both procedures.