Laparoscopic versus open pancreaticoduodenectomy in patients with periampullary carcinoma: A randomised clinical trial

Introduction: Pancreaticoduodenectomy (PD) is the standard curative surgery for periampullary carcinoma. Laparoscopic PD (LPD) offers minimally invasive advantages, but concerns remain regarding safety, oncological adequacy and perioperative outcomes compared with open PD (OPD). Intraoperative blood loss, a key predictor, is underexplored in randomised controlled trials (RCTs). Patients and Methods: We conducted a single-centre, prospective, and single-blind RCT (January 2018–December 2021). Patients with resectable periampullary carcinoma were randomised to LPD or OPD after staging laparoscopy. The primary endpoint was intra-operative blood loss (Nadler’s and Gross’s equations). The secondary endpoints included operative time, hospital stay, transfusion need, complications, margin status, lymph node, overall survival (OS) and recurrence-free survival (RFS). Results: Thirty-six patients were randomised (18 LPD and 18 OPD). Groups were comparable at baseline. Mean blood loss was significantly lower in LPD ( P = 0.046). Operative time was longer, and hospital stay shorter in LPD, both nonsignificant. Rates of pancreatic fistula, delayed gastric emptying and reoperation were similar. One LPD patient had an R1 resection; all others achieved R0. Lymph node yield was comparable. At the follow-up, 3-year OS and 2-year RFS were similar. Conclusion: LPD significantly reduced intra-operative blood loss with comparable oncological and survival outcomes. It is safe and feasible in patients, although larger multicentre trials are warranted to confirm long-term benefits.