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Data of 19 cohort studies including 459 patients were assessed. Results of six controlled trials comprising 129 L-DPPHRt and 205 L-PD for benign neoplasms were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      L-DPPHRt was performed for 123 IPMNs, 44 MCNs, 98 SPNs, 102 SCNs, and 59 PNETs. 90-day mortality was 2 of 459 patients (0.43%). Pancreatic fistula\n                      <jats:italic>B<\/jats:italic>\n                      \/\n                      <jats:italic>C<\/jats:italic>\n                      occurred in 83 patients (18.08%) and biliary fistula in 35 patients (7.62%). Incidence of POPF\n                      <jats:italic>B<\/jats:italic>\n                      \u2009+\u2009\n                      <jats:italic>C<\/jats:italic>\n                      following complete and incomplete L-DPPHRt was 36\/256 pats. (14.06%) and 40\/167 pats. (23.95%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.030), respectively. LHS was 14.24\u00a0days (mean). Laparoscopic total DPPHR unveiled very low risk of hospital mortality (1\/459 pats.;0.21%), reoperation (9\/364 pats.;2.47%), DGE (14\/280 pats.;5.0%), CBD stenosis (2\/459 pats.;0.43%), and ischemic lesion of CBD (2\/459 pats.;0.43%). Comparing 129 L-DPPHRt with 205 L-PD patients revealed overall mean values of 239. vs. 343\u00a0min. for OP time and 128\u00a0ml vs. 240\u00a0ml for estimated blood loss. Meta analysis using standardized mean difference (SMD) demonstrated these differences to be significant (OP time: SMD \u2212\u00a01.20, 95% CI \u2212\u00a02.08 to 0.31;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008; blood loss: SMD \u2212\u00a01.77, 95% CI \u2212\u00a02.87 to \u2212\u00a00.66;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). L-DPPHRt was associated with better intraoperative and early postoperative performance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Laparoscopic DPPHR for cystic neoplasms and PNETs is a low-risk procedure leading to cure of patients. L-DPPHRt accomplishes the most appropriate goals for treatment of patients with benign, premalignant, cystic neoplasms, and PNETs (&gt;\u20092\u00a0cm) of the pancreatic head.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-12585-z","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T17:16:03Z","timestamp":1770398163000},"page":"1852-1865","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Laparoscopic duodenum-preserving pancreatic head resection in 459 patients for precancerous, cystic neoplasms, and neuroendocrine tumors. 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