Langenbeck's Archives of Surgery

, Volume 393, Issue 3, pp 391–395 | Cite as

Laparoscopic vs open resection of pancreatic endocrine neoplasms: single institution’s experience over 14 years

  • Andrew A. Gumbs
  • Philippe Grès
  • Fabio Madureira
  • Brice Gayet
Original Article

Abstract

Background

Laparoscopic resection of benign pancreatic endocrine neoplasms (PENs) has become the standard of care for tumors in the pancreatic tail. Over a 14-year period, we have resected both benign and malignant tumors of the entire pancreas laparoscopically and compared our survival and complication rates with open controls.

Materials and methods

We collected our data retrospectively and reviewed our outcomes with an actuarial 5-year survival according to Kaplan–Meier. Patients who underwent minimally invasive techniques were compared to patients who were approached with open techniques.

Results

From April 1992 to September 2006, we operated on 31 patients for PENs: 13 (42%) were operated on using open techniques and 18 (58%) laparoscopically, and conversion occurred in one patient (6%). In the laparoscopic group, eight (47%) tumors were malignant compared to six (43%) in the open group. Operative times averaged 188 min for the minimally invasive approach and 305 min for the open approach (p = 0.02). Length of stay was 25 days (range 8–82) for the laparoscopic group compared to 20 days (range 6–63; p > 0.05). Overall morbidity and fistula rates ranged from 67 to 24% in the laparoscopic group to 69 to 38% in the open group (p > 0.05). There were no postoperative mortalities. The average follow-up was 63 months for the open group and 33 months for the laparoscopic group. The overall actuarial survival rates were both 90% at 5 years.

Conclusions

Laparoscopic resection of benign and malignant PENs has similar overall complication and 5-year survival rates as the open technique; however, the laparoscopic approach is associated with shorter operative times.

Keywords

Laparoscopic Pancreatic Endocrine Tumors PET Neoplasm Neoplasia PEN Islet cell tumors 

References

  1. 1.
    Gumbs AA, Moore PS, Falconi M et al (2002) Review of the clinical, histological, and molecular aspects of pancreatic endocrine neoplasms. J Surg Oncol 81(1):45–53 (discussion 54, Sep)PubMedCrossRefGoogle Scholar
  2. 2.
    Berends FJ, Cuesta MA, Kazemier G et al (2000) Laparoscopic detection and resection of insulinomas. Surgery 128(3):386–391 (Sep)PubMedCrossRefGoogle Scholar
  3. 3.
    Ayav A, Bresler L, Brunaud L, Boissel P (2005) Laparoscopic approach for solitary insulinoma: a multicentre study. Langenbecks Arch Surg 390(2):134–140 (Apr)PubMedCrossRefGoogle Scholar
  4. 4.
    Assalia A, Gagner M (2004) Laparoscopic pancreatic surgery for islet cell tumors of the pancreas. World J Surg 28(12):1239–1247 (Dec)PubMedCrossRefGoogle Scholar
  5. 5.
    Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120(6):1051–1054 (Dec)PubMedCrossRefGoogle Scholar
  6. 6.
    Gagner M, Pomp A (1997) Laparoscopic pancreatic resection: Is it worthwhile? J Gastrointest Surg 1(1):20–25 (discussion 25–26, Jan–Feb)PubMedCrossRefGoogle Scholar
  7. 7.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213 (Aug)PubMedCrossRefGoogle Scholar
  8. 8.
    Pierce RA, Spitler JA, Hawkins WG et al (2006) Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc 21:579–586PubMedCrossRefGoogle Scholar
  9. 9.
    Fernandez-Cruz L, Martinez I, Cesar-Borges G et al (2005) Laparoscopic surgery in patients with sporadic and multiple insulinomas associated with multiple endocrine neoplasia type 1. J Gastrointest Surg 9(3):381–388 (Mar)PubMedCrossRefGoogle Scholar
  10. 10.
    Fernandez-Cruz L, Saenz A, Astudillo E et al (2002) Outcome of laparoscopic pancreatic surgery: endocrine and nonendocrine tumors. World J Surg 26(8):1057–1065 (Aug)PubMedCrossRefGoogle Scholar
  11. 11.
    Smith S, Branton S, Avino A et al (1998) Vasoactive intestinal polypeptide secreting islet cell tumors: a 15-year experience and review of the literature. Surgery 124:1050–1055PubMedCrossRefGoogle Scholar
  12. 12.
    Van Nieuwenhove Y, Delvaux G (1999) Laparoscopic management of neuroendocrine tumours of the pancreas. Acta Chir Belg 99(5):249–252 (Oct)PubMedGoogle Scholar
  13. 13.
    Spitz JD, Lilly MC, Tetik C, Arregui ME (2000) Ultrasound-guided laparoscopic resection of pancreatic islet cell tumors. Surg Laparosc Endosc Percutan Tech 10(3):168–173 (Jun)PubMedCrossRefGoogle Scholar
  14. 14.
    Machi J, Sigel B (1996) Operative ultrasound in general surgery. Am J Surg 172(1):15–20 (Jul)PubMedCrossRefGoogle Scholar
  15. 15.
    Marescaux J, Mutter D, Vix M, Leroy J (1999) Endoscopic surgery: ideal for endocrine surgery? World J Surg 23(8):825–834 (Aug)PubMedCrossRefGoogle Scholar
  16. 16.
    Menack MJ, Arregui ME (2000) Laparoscopic sonography of the biliary tree and pancreas. Surg Clin North Am 80(4):1151–1170 (Aug)PubMedCrossRefGoogle Scholar
  17. 17.
    Reynolds LR, Park AE, Miller RE, Karounos DG (2002) Combined use of calcium infusion localization and a minimally invasive surgical procedure in the management of insulinoma. Endocr Pract 8(5):329–334 (Sep–Oct)PubMedGoogle Scholar
  18. 18.
    Park AE, Heniford BT (2002) Therapeutic laparoscopy of the pancreas. Ann Surg 236(2):149–158 (Aug)PubMedCrossRefGoogle Scholar
  19. 19.
    Warshaw L (1998) Conservation of the spleen with distal pancreatectomy. Arch Surg 123:550–553Google Scholar
  20. 20.
    Mori T, Abe N, Sugiyama M, Atomi Y (2005) Laparoscopic pancreatic surgery. J Hepatobiliary Pancreat Surg 12(6):451–455PubMedCrossRefGoogle Scholar
  21. 21.
    Ammori BJ, El-Dhuwaib Y, Ballester P, Augustine T (2005) Laparoscopic distal pancreatectomy for neuroendocrine tumors of the pancreas. Hepatogastroenterology 52(62):620–624 (Mar–Apr)PubMedGoogle Scholar
  22. 22.
    Thompson N (1998) Management of pancreatic endocrine tumors in patients with multiple endocrine neoplasia type I. Surg Oncol Clin N Am 7:881PubMedGoogle Scholar
  23. 23.
    Shimizu S, Tanaka M, Konomi H, Mizumoto K, Yamaguchi K (2004) Laparoscopic pancreatic surgery: current indications and surgical results. Surg Endosc 18(3):402–406 (Mar)PubMedCrossRefGoogle Scholar
  24. 24.
    Shimizu S, Tanaka M, Konomi H, Tamura T, Mizumoto K, Yamaguchi K (2004) Spleen-preserving laparoscopic distal pancreatectomy after division of the splenic vessels. J Laparoendosc Adv Surg Tech A 14(3):173–177 (Jun)PubMedCrossRefGoogle Scholar
  25. 25.
    Mori T, Abe N, Sugiyama M, Atomi Y (2002) Laparoscopic hepatobiliary and pancreatic surgery: an overview. J Hepatobiliary Pancreat Surg 9(6):710–722PubMedCrossRefGoogle Scholar
  26. 26.
    Toniato A, Meduri F, Foletto M, Avogaro A, Pelizzo M (2006) Laparoscopic treatment of benign insulinomas localized in the body and tail of the pancreas: a single-center experience. World J Surg 30(10):1916–1919 (discussion 1920–1911, Oct)PubMedCrossRefGoogle Scholar
  27. 27.
    Edwin B, Mala T, Mathisen O et al (2004) Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg Endosc 18(3):407–411 (Mar)PubMedCrossRefGoogle Scholar
  28. 28.
    Sa Cunha A, Beau C, Rault A, Catargi B, Collet D, Masson B (2007) Laparoscopic versus open approach for solitary insulinoma. Surg Endosc 21(1):103–108 (Jan)PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Andrew A. Gumbs
    • 1
  • Philippe Grès
    • 1
  • Fabio Madureira
    • 1
  • Brice Gayet
    • 1
  1. 1.Department of Medical and Surgical Digestive Diseases, Institut Mutualiste MontsourisUniversité René Descartes Paris VParisFrance

Personalised recommendations