Laparoscopic pancreaticoduodenectomy (LPD), a surgical option for nonpancreatic periampullary adenocarcinoma (NPPA), is a complex procedure that has become increasing popular. However, there is no consensus as to whether this technique should be performed routinely. Our aim was to evaluate the outcomes of LPD compared with open pancreaticoduodenectomy (OPD).

Inclusion Criteria:

• • Body mass index <28.0 kg/m2.

  • Ampullary tumors, duodenal tumors restricted to the second part of the duodenum, or lower common bile duct tumors.
  • Carefully confirmed resectability of the tumors based on preoperative radiology conducted by experienced radiologists and surgeons.

Exclusion Criteria:

• • Patients with >180 degrees superior mesenteric artery encasement

  • Any celiac abutment.
  • Unreconstructable superior mesenteric vein/portal occlusion" Aortic invasion or encasement.
  • A history of previous upper abdominal surgery.
  • Tumors extending to the uncinate.
  • Severe cardiorespiratory comorbidities.