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Minimally Invasive Pancreatectomy for Cancer: A Critical Review of the Current Literature

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Minimally invasive surgery (MIS) has transformed operative practices by offering patients procedures with reduced hospital stay and recovery compared to that of open operations. In spite of the advantages of a MIS approach, the application to pancreatectomy has only recently emerged. This review aims to analyze and discuss available comparative studies as they relate to resection techniques for treatment of malignant disease. A PubMed search was used to obtain original studies and meta-analyses relating to MIS pancreatectomy from 2008 to 2013. Several studies were identified that reported on the application of MIS specifically to the treatment of cancer, many of which were retrospective, single-institution studies. Notwithstanding an inherent selection bias, several studies suggest that MIS can provide equivalent R0 resection rates, number of lymph nodes harvested, and survival to that of open resection. Furthermore, parameters such as blood loss and length of stay are significantly reduced in patients treated with MIS. The current literature supports the conclusion that MIS is safe and effective as a treatment for cancer in well-selected patients in the hands of experienced surgeons. However, the published studies to date are observational in nature and therefore higher quality studies will be needed to support the application and generalizability of MIS in the treatment of pancreatic malignancies.

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References

  1. Whipple AO, Parsons WB, Mullins CR (1935) Treatment of Carcinoma of the Ampulla of Vater. Annals of surgery 102:763–779

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Mezhir JJ (2013) Optimizing pancreatectomy outcomes: follow the evidence. The Journal of surgical research 181:213–215

    Article  PubMed  Google Scholar 

  3. Winter JM, Brennan MF, Tang LH, D’Angelica MI, Dematteo RP, Fong Y, Klimstra DS, Jarnagin WR, Allen PJ (2012) Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Annals of surgical oncology 19:169–175

    Article  PubMed  Google Scholar 

  4. Polychronidis A, Laftsidis P, Bounovas A, Simopoulos C (2008) Twenty years of laparoscopic cholecystectomy: Philippe Mouret–March 17, 1987. JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 12:109–111

    Google Scholar 

  5. Hutteman M, van der Vorst JR, Mieog JS, Bonsing BA, Hartgrink HH, Kuppen PJ, Lowik CW, Frangioni JV, van de Velde CJ, Vahrmeijer AL (2011) Near-infrared fluorescence imaging in patients undergoing pancreaticoduodenectomy. European surgical research Europaische chirurgische Forschung Recherches chirurgicales europeennes 47:90–97

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Byrn JC, Schluender S, Divino CM, Conrad J, Gurland B, Shlasko E, Szold A (2007) Three-dimensional imaging improves surgical performance for both novice and experienced operators using the da Vinci Robot System. American journal of surgery 193:519–522

    Article  PubMed  Google Scholar 

  7. Marano A, Priora F, Lenti LM, Ravazzoni F, Quarati R, Spinoglio G (2013) Application of fluorescence in robotic general surgery: review of the literature and state of the art. World journal of surgery 37:2800–2811

    Article  PubMed  Google Scholar 

  8. Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surgical endoscopy 8:408–410

    Article  CAS  PubMed  Google Scholar 

  9. Cuschieri A (1994) Laparoscopic surgery of the pancreas. Journal of the Royal College of Surgeons of Edinburgh 39:178–184

    CAS  PubMed  Google Scholar 

  10. Sarlos D, Kots L, Stevanovic N, Schaer G (2010) Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case–control study. European journal of obstetrics, gynecology, and reproductive biology 150:92–96

    Article  PubMed  Google Scholar 

  11. Breitenstein S, Nocito A, Puhan M, Held U, Weber M, Clavien PA (2008) Robotic-assisted versus laparoscopic cholecystectomy: outcome and cost analyses of a case-matched control study. Annals of surgery 247:987–993

    Article  PubMed  Google Scholar 

  12. Delaney CP, Lynch AC, Senagore AJ, Fazio VW (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Diseases of the colon and rectum 46:1633–1639

    Article  PubMed  Google Scholar 

  13. Boggi U, Signori S, De Lio N, Perrone VG, Vistoli F, Belluomini M, Cappelli C, Amorese G, Mosca F (2013) Feasibility of robotic pancreaticoduodenectomy. The British journal of surgery 100:917–925

    Article  CAS  PubMed  Google Scholar 

  14. Kang CM, Kim DH, Lee WJ, Chi HS (2011) Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surgical endoscopy 25:2004–2009

    Article  PubMed  Google Scholar 

  15. Siwek J, Gourlay ML, Slawson DC, Shaughnessy AF (2002) How to write an evidence-based clinical review article. American family physician 65:251–258

    PubMed  Google Scholar 

  16. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ, Group GW (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Bmj 336:924–926

    Article  Google Scholar 

  17. Kneuertz PJ, Patel SH, Chu CK, Fisher SB, Maithel SK, Sarmiento JM, Weber SM, Staley CA, Kooby DA (2012) Laparoscopic distal pancreatectomy: trends and lessons learned through an 11-year experience. Journal of the American College of Surgeons 215:167–176

    Article  PubMed  Google Scholar 

  18. Marangos IP, Buanes T, Rosok BI, Kazaryan AM, Rosseland AR, Grzyb K, Villanger O, Mathisen O, Gladhaug IP, Edwin B (2012) Laparoscopic resection of exocrine carcinoma in central and distal pancreas results in a high rate of radical resections and long postoperative survival. Surgery 151:717–723

    Article  PubMed  Google Scholar 

  19. DiNorcia J, Schrope BA, Lee MK, Reavey PL, Rosen SJ, Lee JA, Chabot JA, Allendorf JD (2010) Laparoscopic distal pancreatectomy offers shorter hospital stays with fewer complications. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract 14:1804–1812

    Article  Google Scholar 

  20. Nakamura M, Nakashima H (2013) Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. Journal of hepato-biliary-pancreatic sciences 20:421–428

    Article  PubMed  Google Scholar 

  21. Xie K, Zhu YP, Xu XW, Chen K, Yan JF, Mou YP (2012) Laparoscopic distal pancreatectomy is as safe and feasible as open procedure: a meta-analysis. World journal of gastroenterology: WJG 18:1959–1967

    Article  PubMed Central  PubMed  Google Scholar 

  22. Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL (2012) Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Annals of surgery 255:1048–1059

    Article  PubMed  Google Scholar 

  23. Jin T, Altaf K, Xiong JJ, Huang W, Javed MA, Mai G, Liu XB, Hu WM, Xia Q (2012) A systematic review and meta-analysis of studies comparing laparoscopic and open distal pancreatectomy. HPB: the official journal of the International Hepato Pancreato Biliary Association 14:711–724

    Article  Google Scholar 

  24. Pericleous S, Middleton N, McKay SC, Bowers KA, Hutchins RR (2012) Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure? Pancreas 41:993–1000

    Article  PubMed  Google Scholar 

  25. Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC, 3rd, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? Journal of the American College of Surgeons 210:779–785, 786–777

    Google Scholar 

  26. Jayaraman S, Gonen M, Brennan MF, D’Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR, Allen PJ (2010) Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. Journal of the American College of Surgeons 211:503–509

    Article  PubMed  Google Scholar 

  27. Tran Cao HS, Lopez N, Chang DC, Lowy AM, Bouvet M, Baumgartner JM, Talamini MA, Sicklick JK (2014) Improved perioperative outcomes with minimally invasive distal pancreatectomy: results from a population-based analysis. JAMA surgery 149:237–243

    Article  PubMed  Google Scholar 

  28. Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin RC, 2nd, Scoggins CR, Ahmad S, Kim HJ, Park J, Johnston F, Strouch MJ, Menze A, Rymer J, McClaine R, Strasberg SM, Talamonti MS, Staley CA, McMasters KM, Lowy AM, Byrd-Sellers J, Wood WC, Hawkins WG (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Annals of surgery 248:438–446

    PubMed  Google Scholar 

  29. Magge D, Gooding W, Choudry H, Steve J, Steel J, Zureikat A, Krasinskas A, Daouadi M, Lee KK, Hughes SJ, Zeh HJ, 3rd, Moser AJ (2013) Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma. JAMA surgery 148:525–531

    Article  PubMed  Google Scholar 

  30. Daouadi M, Zureikat AH, Zenati MS, Choudry H, Tsung A, Bartlett DL, Hughes SJ, Lee KK, Moser AJ, Zeh HJ (2013) Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Annals of surgery 257:128–132

    Article  PubMed  Google Scholar 

  31. Wayne M, Steele J, Iskandar M, Cooperman A (2013) Robotic pancreatic surgery – no substitute for experience and clinical judgment: an initial experience and literature review. World journal of surgical oncology 11:160

    Article  PubMed Central  PubMed  Google Scholar 

  32. Zureikat AH, Nguyen KT, Bartlett DL, Zeh HJ, Moser AJ (2011) Robotic-assisted major pancreatic resection and reconstruction. Archives of surgery 146:256–261

    Article  PubMed  Google Scholar 

  33. Winer J, Can MF, Bartlett DL, Zeh HJ, Zureikat AH (2012) The current state of robotic-assisted pancreatic surgery. Nature reviews Gastroenterology & hepatology 9:468–476

    Article  Google Scholar 

  34. Nguyen KT, Zureikat AH, Chalikonda S, Bartlett DL, Moser AJ, Zeh HJ (2011) Technical aspects of robotic-assisted pancreaticoduodenectomy (RAPD). Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract 15:870–875

    Article  Google Scholar 

  35. Gumbs AA, Rodriguez Rivera AM, Milone L, Hoffman JP (2011) Laparoscopic pancreatoduodenectomy: a review of 285 published cases. Annals of surgical oncology 18:1335–1341

    Article  PubMed  Google Scholar 

  36. Asbun HJ, Stauffer JA (2012) Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. Journal of the American College of Surgeons 215:810–819

    Article  PubMed  Google Scholar 

  37. Kuroki T, Adachi T, Okamoto T, Kanematsu T (2012) A non-randomized comparative study of laparoscopy-assisted pancreaticoduodenectomy and open pancreaticoduodenectomy. Hepato-gastroenterology 59:570–573

    PubMed  Google Scholar 

  38. Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh HJ, 3rd (2013) 250 robotic pancreatic resections: safety and feasibility. Annals of surgery 258:554–559; discussion 559–562

    PubMed  Google Scholar 

  39. Zeh HJ, Bartlett DL, Moser AJ (2011) Robotic-Assisted Major Pancreatic Resection. Advances in Surgery 45:323–340

    Article  PubMed  Google Scholar 

  40. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract 10:1199–1210; discussion 1210–1191

    Article  Google Scholar 

  41. Fernandez-del Castillo C, Morales-Oyarvide V, McGrath D, Wargo JA, Ferrone CR, Thayer SP, Lillemoe KD, Warshaw AL (2012) Evolution of the Whipple procedure at the Massachusetts General Hospital. Surgery 152:S56-63

    Article  PubMed  Google Scholar 

  42. Kendrick ML, Cusati D (2010) Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Archives of surgery 145:19–23

    Article  PubMed  Google Scholar 

  43. Stauffer JA, Rosales-Velderrain A, Goldberg RF, Bowers SP, Asbun HJ (2013) Comparison of open with laparoscopic distal pancreatectomy: a single institution’s transition over a 7-year period. HPB: the official journal of the International Hepato Pancreato Biliary Association 15:149–155

    Article  Google Scholar 

  44. Gagner M, Palermo M (2009) Laparoscopic Whipple procedure: review of the literature. Journal of hepato-biliary-pancreatic surgery 16:726–730

    Article  PubMed  Google Scholar 

  45. Kim SC, Song KB, Jung YS, Kim YH, Park DOH, Lee SS, Seo DW, Lee SK, Kim MH, Park KM, Lee YJ (2013) Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surgical endoscopy 27:95–103

    Article  PubMed  Google Scholar 

  46. Chalikonda S, Aguilar-Saavedra JR, Walsh RM (2012) Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surgical endoscopy 26:2397–2402

    Article  CAS  PubMed  Google Scholar 

  47. Buchs NC, Addeo P, Bianco FM, Ayloo S, Benedetti E, Giulianotti PC (2011) Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World journal of surgery 35:2739–2746

    Article  PubMed  Google Scholar 

  48. Lai EC, Yang GP, Tang CN (2012) Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy—a comparative study. International journal of surgery 10:475–479

    Article  PubMed  Google Scholar 

  49. Zhang J, Wu WM, You L, Zhao YP (2013) Robotic versus open pancreatectomy: a systematic review and meta-analysis. Annals of surgical oncology 20:1774–1780

    Article  PubMed  Google Scholar 

  50. Buchs NC, Addeo P, Bianco FM, Gangemi A, Ayloo SM, Giulianotti PC (2010) Outcomes of robot-assisted pancreaticoduodenectomy in patients older than 70 years: a comparative study. World journal of surgery 34:2109–2114

    Article  PubMed  Google Scholar 

  51. Fox AM, Pitzul K, Bhojani F, Kaplan M, Moulton CA, Wei AC, McGilvray I, Cleary S, Okrainec A (2012) Comparison of outcomes and costs between laparoscopic distal pancreatectomy and open resection at a single center. Surgical endoscopy 26:1220–1230

    Article  PubMed  Google Scholar 

  52. Abu Hilal M, Hamdan M, Di Fabio F, Pearce NW, Johnson CD (2012) Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study. Surgical endoscopy 26:1670–1674

    Article  PubMed  Google Scholar 

  53. Waters JA, Canal DF, Wiebke EA, Dumas RP, Beane JD, Aguilar-Saavedra JR, Ball CG, House MG, Zyromski NJ, Nakeeb A, Pitt HA, Lillemoe KD, Schmidt CM (2010) Robotic distal pancreatectomy: cost effective? Surgery 148:814–823

    Article  PubMed  Google Scholar 

  54. Limongelli P, Belli A, Russo G, Cioffi L, D’Agostino A, Fantini C, Belli G (2012) Laparoscopic and open surgical treatment of left-sided pancreatic lesions: clinical outcomes and cost-effectiveness analysis. Surgical endoscopy 26:1830–1836

    Article  PubMed  Google Scholar 

  55. Mesleh MG, Stauffer JA, Bowers SP, Asbun HJ (2013) Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison. Surgical endoscopy 27:4518–4523

    Article  PubMed  Google Scholar 

  56. Al-Refaie WB, Parsons HM, Markin A, Abrams J, Habermann EB (2012) Blood transfusion and cancer surgery outcomes: a continued reason for concern. Surgery 152:344–354

    Article  PubMed  Google Scholar 

  57. Cata JP, Wang H, Gottumukkala V, Reuben J, Sessler DI (2013) Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. British journal of anaesthesia 110:690–701

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. Sun RC, Button AM, Smith BJ, Leblond RF, Howe JR, Mezhir JJ (2013) A comprehensive assessment of transfusion in elective pancreatectomy: risk factors and complications. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract 17:627–635

    Article  CAS  Google Scholar 

  59. Lee GC, Fong ZV, Ferrone CR, Thayer SP, Warshaw AL, Lillemoe KD, Fernandez-Del Castillo C (2014) High performing whipple patients: factors associated with short length of stay after open pancreaticoduodenectomy. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract 18:1760–1769

    Article  Google Scholar 

  60. Baker MS, Bentrem DJ, Ujiki MB, Stocker S, Talamonti MS (2009) A prospective single institution comparison of peri-operative outcomes for laparoscopic and open distal pancreatectomy. Surgery 146:635–643; discussion 643–635

    Article  PubMed  Google Scholar 

  61. Finan KR, Cannon EE, Kim EJ, Wesley MM, Arnoletti PJ, Heslin MJ, Christein JD (2009) Laparoscopic and open distal pancreatectomy: a comparison of outcomes. The American surgeon 75:671–679; discussion 679–680

    PubMed  Google Scholar 

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Place, T.L., Nau, P. & Mezhir, J.J. Minimally Invasive Pancreatectomy for Cancer: A Critical Review of the Current Literature. J Gastrointest Surg 19, 375–386 (2015). https://doi.org/10.1007/s11605-014-2695-x

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