Background:Minimally invasive pancreatoduodenectomy (MIPD) has evolved from an experimental technique to a feasible surgical option for pancreatic cancer in selected settings. However, its oncologic adequacy, safety, and generalizability remain debated, particularly given the biological aggressiveness of pancreatic ductal adenocarcinoma (PDAC) and the technical complexity of the procedure.Methods:This narrative review critically summarizes contemporary evidence regarding MIPD for pancreatic cancer, with particular attention to randomized controlled trials (RCTs), meta-analyses, and large observational studies. We distinguish findings derived from mixed periampullary tumor cohorts from those specific to PDAC and evaluate methodological limitations, learning-curve effects, and sources of heterogeneity across studies.Results:Recent RCTs and meta-analyses demonstrate that, when performed by experienced surgeons in high-volume centers, MIPD achieves perioperative outcomes comparable to open pancreatoduodenectomy, with advantages including reduced blood loss, shorter hospital stay, and faster functional recovery. Importantly, oncologic parameters such as R0 resection rates and lymph node yield appear equivalent between approaches, although robust long-term survival data from PDAC-specific RCTs remain lacking. Emerging evidence supports the feasibility of MIPD in complex clinical scenarios, including after neoadjuvant therapy, in frail or elderly patients, and in selected cases requiring vascular resection. Nonetheless, outcomes are strongly influenced by surgeon experience, institutional volume, and patient selection. Cost-effectiveness analyses and data from lower-volume centers remain limited.Conclusions:Current evidence supports MIPD as a viable alternative to open surgery for pancreatic cancer in carefully selected patients treated at specialized centers. However, claims of oncologic superiority are premature. Future research should focus on PDAC-specific randomized trials, standardized quality metrics, and strategies to mitigate learning-curve and resource-related barriers to broader implementation.
背景：微创胰十二指肠切除术（MIPD）已从一种实验性技术发展为特定条件下胰腺癌的可行手术选择。然而，其肿瘤学充分性、安全性和普适性仍存在争议，特别是考虑到胰腺导管腺癌（PDAC）的生物学侵袭性和手术的技术复杂性。
方法：本叙述性综述批判性地总结了有关胰腺癌MIPD的当代证据，特别关注随机对照试验（RCTs）、荟萃分析和大型观察性研究。我们区分了来自壶腹周围混合肿瘤队列的研究结果与PDAC特异性结果，并评估了各研究的方法学局限性、学习曲线效应以及异质性来源。
结果：近期的RCTs和荟萃分析表明，在由高手术量中心的经验丰富外科医生实施时，MIPD能够达到与开放胰十二指肠切除术相当的围手术期结果，其优势包括减少失血量、缩短住院时间和更快功能恢复。重要的是，尽管仍缺乏来自PDAC特异性RCT的可靠长期生存数据，但R0切除率和淋巴结获取数量等肿瘤学参数在两种手术方式间似乎相当。新兴证据支持MIPD在复杂临床场景中的可行性，包括新辅助治疗后、体弱或老年患者，以及需要血管切除的特定病例。尽管如此，手术结果仍深受外科医生经验、机构手术量和患者选择的影响。成本效益分析和低手术量中心的数据仍然有限。
结论：现有证据支持在专科中心对经过严格筛选的胰腺癌患者，MIPD可作为开放手术的可行替代方案。然而，关于其肿瘤学优势的说法为时过早。未来研究应重点关注PDAC特异性随机试验、标准化质量指标，以及减轻学习曲线和资源相关障碍以实现更广泛应用的策略。
肿瘤(癌症)患者之家