The Landmark Series: Minimally Invasive Pancreatic Resection for Ductal Adenocarcinoma, Updates, Trends, and Future Considerations

Abstract

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) remains a formidable malignancy, with historically high morbidity and mortality following surgical resection. Over the past two decades, minimally invasive pancreatic resection (MIPR)-encompassing both laparoscopic and robotic approaches-has emerged as a promising alternative to conventional open techniques, offering potential advantages in perioperative recovery while aiming to maintain oncologic standards. OBJECTIVE: This review aims to synthesize the evidence guiding the adoption of MIPR for PDAC and to highlight technical innovations, training considerations, and future directions in this evolving field. METHODS: A focused appraisal of key retrospective analyses, prospective randomized trials, and meta-analyses was conducted. Emphasis was placed on oncologic outcomes, perioperative morbidity, learning curve dynamics, and patient selection criteria. RESULTS: Overall, the studies reviewed suggest that MIPR can achieve equivalent oncologic outcomes-specifically in margin status and lymph node yield-relative to open resection. Advantages include reduced intraoperative blood loss, shorter hospital stays, and faster functional recovery, most consistently demonstrated for distal pancreatectomy. However, the technical complexity of minimally invasive pancreatoduodenectomy necessitates structured training and high-volume centers to mitigate safety concerns. Increasing use of neoadjuvant therapy also intersects with MIPR, necessitating careful patient selection and multidisciplinary coordination. CONCLUSIONS: Minimally invasive pancreatic resection has become a valid option for patients with PDAC, particularly for distal lesions, and holds promise for broader application pending further refinements. Rigorous training programs, thoughtful patient selection, and ongoing trials will be crucial to optimizing outcomes and solidifying MIPR as a mainstay in pancreatic cancer management.