Work

Minimally Invasive Versus Open Pancreaticoduodenectomy for Distal Cholangiocarcinoma: An Updated Disease-Specific Systematic Review and Meta-Analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background/Objectives: Distal cholangiocarcinoma is a rare biliary tract cancer typically treated with pancreaticoduodenectomy. Comparative evidence specifically addressing minimally invasive versus open pancreaticoduodenectomy for this disease remains scarce. Methods: We conducted an updated systematic review and pairwise meta-analysis of comparative studies limited to distal cholangiocarcinoma. Binary outcomes were summarized as odds ratios, continuous outcomes as mean differences, and overall survival as hazard ratios. The primary survival analysis included only directly reported hazard ratios from prespecified matched or weighted cohorts; hazard ratios reconstructed from Kaplan–Meier curves were examined only in sensitivity analyses. Results: Six retrospective comparative studies involving 1623 patients met the inclusion criteria. Minimally invasive surgery was associated with lower blood loss (mean difference, −104.93 mL; 95% CI, −145.30 to −64.57; I2 = 16.3%). No clear differences were found in clinically relevant postoperative pancreatic fistula (odds ratio, 1.03; 95% CI, 0.85 to 1.25), major morbidity (odds ratio, 0.96; 95% CI, 0.64 to 1.43), or R0 resection (odds ratio, 1.22; 95% CI, 0.96 to 1.56). In the primary overall survival analysis based on directly reported hazard ratios, the pooled hazard ratio was 0.93 (95% CI, 0.57 to 1.52; I2 = 1.3%). In the sensitivity analysis incorporating eligible reconstructed hazard ratios, the pooled hazard ratio was 0.88 (95% CI, 0.73 to 1.05). In an exploratory recurrence-related survival family analysis based on directly reported estimates, the pooled hazard ratio was 0.95 (95% CI, 0.83 to 1.07; I2 = 0.0%). Conclusions: Minimally invasive pancreaticoduodenectomy may reduce blood loss without clear evidence of worse major postoperative or oncologic outcomes in distal cholangiocarcinoma. However, the available evidence is entirely observational and should be interpreted with caution.

Source: Cancers

DOI: 10.3390/cancers18091328

Authors: Yi Li, Yulin Lei, Wenli Yang, Wen Zhong, Ran Cui

Institutions: Third People's Hospital of Chengdu, Southwest Jiaotong University, Southwest Medical University, Affiliated Hospital of Southwest Medical University, The First People's Hospital of Neijiang

Language: English

Topic: Cholangiocarcinoma and Gallbladder Cancer Studies

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,499