Minimally invasive left pancreatectomy for pancreatic ductal adenocarcinoma: review of the current literature

The minimally invasive approach has gained popularity in the last decades, even in complex abdominal surgery such as pancreatic resections. Currently, many meta-analyses focus on the benefits and advantages of the minimally invasive approach compared to open surgery, especially during left pancreatectomy (LP). Limited data on the oncological outcomes are available. The review aims to describe the surgical and oncological outcomes of the minimally invasive left pancreatectomy (MILP). The search terms were based on the final histological pathology (pancreatic adenocarcinoma) and the comparison of different surgical approaches (open vs. minimally invasive). The search strategy was constructed in PubMed and adapted to run across other database platforms, focusing on studies published until 2022. A total of 2,878 studies were selected and duplicates were removed. After title and abstract screening, 109 articles remained for full-text assessment, of which 28 met the eligibility criteria for this systematic review. Considering the study design, the studies were divided into retrospective (n = 15), prospective (n = 4), and 13 propensity score-matched (n = 9). The present review of the literature suggests that MILP is technically feasible and safe for treating body and tail pancreatic ductal adenocarcinoma (PDAC). MILP did not have any impact on the major complications, reducing hospitalization. Regarding the oncological outcomes, the surgical technique did not have an impact on the R0 resection rate, lymph node harvested rate, use of adjuvant chemotherapy, and overall survival. Further prospective randomized trials remain indicated to assess the oncological impact of the MILP in patients with PDAC.