Background and Aims There is currently no consensus on whether the pancreaticoduodenectomy with Heidelberg triangle operation (PD_TRIANGLE) or the standard radical pancreaticoduodenectomy (PD_STANDARD) is more beneficial for patients with pancreatic cancer, and no large-scale multicenter studies have confirmed this. Therefore, this study was conducted to compare the clinical efficacy and safety of PD_TRIANGLE and PD_STANDARD for treating pancreatic cancer through a Meta-analysis.Methods Relevant literature comparing the two surgical approaches comparing the two surgical approaches for treating pancreatic cancer was screened from Chinese and English databases based on inclusion criteria. The search timeframe extended from the inception of the databases to May 2024, and Review Manager 5.3 software was used for Meta-analysis of the extracted outcome variables.Results A total of 6 retrospective studies were included, comprising 658 patients, with 315 in the PD_TRIANGLE group and 343 in the PD_STANDARD group. The Meta-analysis results showed that the operative time in the PD_TRIANGLE group was longer than that in the PD_STANDARD group (OR=1.52, 95% CI=0.42-2.61, P=0.007), the lymph node dissection rate was higher in the PD_TRIANGLE group (OR=0.70, 95% CI=0.4-1.01, P<0.000 01), and the R₀ resection rate was also higher in the PD_TRIANGLE group (OR=1.63, 95% CI=1.03-2.58, P=0.04). The incidence rates of postoperative lymphatic fistula and diarrhea were higher in the PD_TRIANGLE group compared to the PD_STANDARD group (OR=5.60, 95% CI=1.81-17.29, P=0.003; OR=0.13, 95% CI=0.07-0.20, P<0.000 1). The length of hospital stay was longer in the PD_TRIANGLE group (OR=0.40; 95% CI=0.14-0.65, P=0.003). The overall survival rates at 1 and 2 years were significantly better in the PD_TRIANGLE group compared to the PD_STANDARD group (OR=2.19, 95% CI=1.27-3.76, P=0.005; OR=1.65, 95% CI=1.01-2.67, P=0.04), and the 1-year disease-free survival rate was also significantly higher in the PD_TRIANGLE group (OR=3.71, 95% CI=2.27-6.07, P<0.000 01), although the difference in the 2-year disease-free survival rate between the two groups was not statistically significant (OR=2.63, 95% CI=0.91-7.59, P=0.07).Conclusion PD_TRIANGLE is a safe and effective treatment for pancreatic cancer. Compared to PD_STANDARD, PD_TRIANGLE significantly improves the R₀ resection rate, thereby enhancing the postoperative disease-free survival rate and achieving a better long-term prognosis.