Abstract:Minimally invasive pancreaticoduodenectomy (MIPD) is transitioning from a stage of technical feasibility toward a phase focused on achieving oncologic radicality while maintaining safety. Current evidence suggests that, in high-volume centers with experienced surgical teams, the perioperative safety of MIPD is comparable to that of open pancreaticoduodenectomy. However, its safety profile is influenced not only by the surgical approach, but also by institutional qualification, surgeon experience, case complexity stratification, and the management of key technical steps. Among these, appropriate selection of pancreaticojejunostomy plays a crucial role in reducing complications such as postoperative pancreatic fistula. From an oncologic perspective, MIPD can achieve margin status and R0 resection rates comparable to open surgery. Nevertheless, the persistently high rate of local recurrence and suboptimal long-term survival in pancreatic cancer indicate that true oncologic radicality remains unresolved. Traditional extended resections have not demonstrated clear survival benefits. Emerging concepts such as total mesopancreas excision offer new strategies for improving local control, but their anatomical basis, indications, and clinical value require further validation. With the increasing use of neoadjuvant therapy, inflammation and fibrosis further complicate anatomical identification, margin assessment, and intraoperative decision-making, thereby imposing higher demands on patient selection and surgical judgment. Overall, the evolution of MIPD should extend beyond technical minimal invasiveness toward a more balanced approach that integrates precise patient selection, rigorous difficulty stratification, and robust evidence-based support, aiming to achieve optimal oncologic outcomes without compromising safety.