Background : Pancreatoduodenectomy (PD) is the standard treatment for ampulla of Vater (AoV) cancer, but the optimal surgical approach remains debated. Minimally invasive pancreaticoduodenectomy (MIPD) has been proposed as a less invasive alternative to open pancreaticoduodenectomy (OPD), with potential perioperative benefits and comparable oncologic efficacy. However, direct comparisons of short- and long-term outcomes between the two approaches are limited. This study aimed to evaluate the efficacy and safety of MIPD compared to OPD using propensity score-matched analysis.

Methods : We retrospectively analyzed 260 patients with AoV cancer who underwent PD (89 MIPD and 171 OPD). Short-term outcomes, including operative time, blood loss, major complications, and length of hospital stay, as well as long-term outcomes such as overall survival (OS) and recurrence-free survival (RFS), were analyzed. Propensity score matching (PSM) was employed to minimize baseline differences.

Results : Before PSM, MIPD was associated with longer operative time (p<0.001), less blood loss (p<0.001), and shorter hospital stay (p<0.001) compared to OPD, with similar major complication rates (p=0.881). Oncologic outcomes showed no significant differences in OS (p=0.865) or RFS (p=0.088). After PSM, perioperative benefits of MIPD persisted, with reduced blood loss (p<0.001) and shorter hospital stay (p=0.034). Major complication rates remained similar (p=0.552). OS (p=0.932) and RFS (p=0.100) were also comparable between groups.

Conclusions : MIPD is a viable alternative to OPD for AoV cancer, offering similar long-term outcomes and perioperative benefits. These findings emphasize the importance of patient selection and further research into optimizing surgical and adjuvant strategies.