Advertisement

Surgical Endoscopy

, Volume 31, Issue 5, pp 2310–2316 | Cite as

Role of laparoscopic enucleation in the treatment of pancreatic lesions: case series and case-matched analysis

  • Mushegh A. SahakyanEmail author
  • Bård Ingvald Røsok
  • Airazat M. Kazaryan
  • Leonid Barkhatov
  • Sven-Petter Haugvik
  • Åsmund Avdem Fretland
  • Dejan Ignjatovic
  • Knut Jørgen Labori
  • Bjørn Edwin
Article

Abstract

Background

Previous studies report successful application of laparoscopic pancreatic enucleation (LPE). However, the evidence is limited to small series. This study aimed to evaluate the indications, technique and outcome of LPE at a tertiary care institution.

Methods

Between February 1998 and April 2016, 45 consecutive LPEs were performed at Oslo University Hospital—Rikshospitalet. Twenty-four (53.3 %) patients subjected to right-sided LPE (RLPE) were compared with 21 (46.7 %) patients who had undergone left-sided LPE (LLPE). A case-matched analysis (1:2) was performed to compare the outcomes following LLPE and laparoscopic distal pancreatectomy (LDP).

Results

Patient demographics, BMI, ASA score and pathological characteristics were similar between the RLPE and LLPE groups. Operative time was slightly longer for RLPE [123 (53–320) vs 102 (50–373) min, P = 0.09]. The rates of severe morbidity (≥Accordion grade III) and clinically relevant pancreatic fistula (grades B/C) were comparable, although with a trend for higher rate of complications following LLPE (16.7 vs 33.3 %; P = 0.19 and 20.8 vs 33.3 %, P = 0.34, respectively). The hospital stay was similar between RLPE and LLPE [5 (2–80) vs 7 (2–52), P = 0.49]. A case-matched analysis demonstrated shorter operating time [145 (90–350) vs 103 (50–233) min, P = 0.02], but higher readmission rate following LLPE (25 vs 3.1 %, P = 0.037).

Conclusion

LLPE seems to be associated with a higher risk of postoperative morbidity and readmission rates than LDP. RLPE is a feasible, safe approach and a reasonable alternative to pancreatoduodenectomy in selected patients with pancreatic lesions.

Keywords

Laparoscopy Enucleation Pancreatectomy Morbidity Pancreatic fistula 

Notes

Compliance with ethical standards

Disclosures

Mushegh A. Sahakyan, Bård Ingvald Røsok, Airazat M. Kazaryan, Leonid Barkhatov, Sven-Petter Haugvik, Åsmund Avdem Fretland, Dejan Ignjatovic, Knut-Jørgen Labori and Bjørn Edwin have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Muller MW, Friess H, Kleeff J, Hinz U, Wente MN, Paramythiotis D et al (2006) Middle segmental pancreatic resection: an option to treat benign pancreatic body lesions. Ann Surg 244(6):909–918 (Discussion 18-20) CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kahl S, Malfertheiner P (2004) Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. Best Pract Res Clin Gastroenterol 18(5):947–955CrossRefPubMedGoogle Scholar
  3. 3.
    Brient C, Regenet N, Sulpice L, Brunaud L, Mucci-Hennekine S, Carrere N et al (2012) Risk factors for postoperative pancreatic fistulization subsequent to enucleation. J Gastrointest Surg 16(10):1883–1887CrossRefPubMedGoogle Scholar
  4. 4.
    Cauley CE, Pitt HA, Ziegler KM, Nakeeb A, Schmidt CM, Zyromski NJ et al (2012) Pancreatic enucleation: improved outcomes compared to resection. J Gastrointest Surg 16(7):1347–1353CrossRefPubMedGoogle Scholar
  5. 5.
    Zhang T, Xu J, Wang T, Liao Q, Dai M, Zhao Y (2013) Enucleation of pancreatic lesions: indications, outcomes, and risk factors for clinical pancreatic fistula. J Gastrointest Surg 17(12):2099–2104CrossRefPubMedGoogle Scholar
  6. 6.
    Chua TC, Yang TX, Gill AJ, Samra JS (2016) Systematic review and meta-analysis of enucleation versus standardized resection for small pancreatic lesions. Ann Surg Oncol 23(2):592–599. doi: 10.1245/s10434-015-4826-3 CrossRefPubMedGoogle Scholar
  7. 7.
    Dedieu A, Rault A, Collet D, Masson B, Sa Cunha A (2011) Laparoscopic enucleation of pancreatic neoplasm. Surg Endosc 25(2):572–576CrossRefPubMedGoogle Scholar
  8. 8.
    Choi KS, Chung JC, Kim HC (2014) Feasibility and outcomes of laparoscopic enucleation for pancreatic neoplasms. Ann Surg Treat Res 87(6):285–289CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Costi R, Randone B, Mal F, Basato S, Levard H, Gayet B (2013) A critical appraisal of laparoscopic pancreatic enucleations: right-sided procedures (Pancreatic Head, Uncus) are not mini-invasive surgery. Surg Laparosc Endosc Percutan Tech 23(6):524–531CrossRefPubMedGoogle Scholar
  10. 10.
    Sweet MP, Izumisato Y, Way LW, Clark OH, Masharani U, Duh QY (2007) Laparoscopic enucleation of insulinomas. Arch Surg (Chicago, Ill: 1960) 142(12):1202–1204 (Discussion 5) CrossRefGoogle Scholar
  11. 11.
    Jilesen AP, van Eijck CH, Busch OR, van Gulik TM, Gouma DJ, van Dijkum EJ (2016) Postoperative outcomes of enucleation and standard resections in patients with a pancreatic neuroendocrine tumor. World J Surg 40(3):715–728. doi: 10.1007/s00268-015-3341-9 CrossRefPubMedGoogle Scholar
  12. 12.
    Zhang RC, Zhou YC, Mou YP, Huang CJ, Jin WW, Yan JF et al (2016) Laparoscopic versus open enucleation for pancreatic neoplasms: clinical outcomes and pancreatic function analysis. Surg Endosc 30(7):2657–2665. doi: 10.1007/s00464-015-4538-6 CrossRefPubMedGoogle Scholar
  13. 13.
    Afridi SA, Kazaryan AM, Marangos IP, Rosok BI, Fretland AA, Yaqub S et al (2014) Laparoscopic surgery for solid pseudopapillary tumor of the pancreas. JSLS J Soc Laparoendosc Surg Soc Laparoendosc Surg 18(2):236–242CrossRefGoogle Scholar
  14. 14.
    Song KB, Kim SC, Hwang DW, Lee JH, Lee DJ, Lee JW et al (2015) Enucleation for benign or low-grade malignant lesions of the pancreas: single-center experience with 65 consecutive patients. Surgery 158(5):1203–1210CrossRefPubMedGoogle Scholar
  15. 15.
    Rosok BI, Marangos IP, Kazaryan AM, Rosseland AR, Buanes T, Mathisen O et al (2010) Single-centre experience of laparoscopic pancreatic surgery. Br J Surg 97(6):902–909CrossRefPubMedGoogle Scholar
  16. 16.
    Haugvik SP, Marangos IP, Rosok BI, Pomianowska E, Gladhaug IP, Mathisen O et al (2013) Long-term outcome of laparoscopic surgery for pancreatic neuroendocrine tumors. World J Surg 37(3):582–590CrossRefPubMedGoogle Scholar
  17. 17.
    Strasberg SM, Linehan DC, Hawkins WG (2009) The accordion severity grading system of surgical complications. Ann Surg 250(2):177–186CrossRefPubMedGoogle Scholar
  18. 18.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo CJ, Izbicki JR et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13CrossRefPubMedGoogle Scholar
  19. 19.
    Mise Y, Day RW, Vauthey JN, Brudvik KW, Schwarz L, Prakash L et al (2016) After pancreatectomy, the “90 days from surgery” definition is superior to the “30 days from discharge” definition for capture of clinically relevant readmissions. J Gastrointest Surg 20(1):77–84CrossRefPubMedGoogle Scholar
  20. 20.
    Ayav A, Bresler L, Brunaud L, Boissel P (2005) Laparoscopic approach for solitary insulinoma: a multicentre study. Langenbeck’s archives of surgery/Deutsche Gesellschaft fur Chirurgie 390(2):134–140CrossRefGoogle Scholar
  21. 21.
    Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J et al (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137(6):597–605CrossRefPubMedGoogle Scholar
  22. 22.
    Fernandez-Cruz L, Blanco L, Cosa R, Rendon H (2008) Is laparoscopic resection adequate in patients with neuroendocrine pancreatic tumors? World J Surg 32(5):904–917CrossRefPubMedGoogle Scholar
  23. 23.
    Luo Y, Liu R, Hu MG, Mu YM, An LC, Huang ZQ (2009) Laparoscopic surgery for pancreatic insulinomas: a single-institution experience of 29 cases. J Gastrointest Surg 13(5):945–950CrossRefPubMedGoogle Scholar
  24. 24.
    Isla A, Arbuckle JD, Kekis PB, Lim A, Jackson JE, Todd JF et al (2009) Laparoscopic management of insulinomas. Br J Surg 96(2):185–190CrossRefPubMedGoogle Scholar
  25. 25.
    Zhao YP, Zhan HX, Zhang TP, Cong L, Dai MH, Liao Q et al (2011) Surgical management of patients with insulinomas: result of 292 cases in a single institution. J Surg Oncol 103(2):169–174CrossRefPubMedGoogle Scholar
  26. 26.
    Costi R, Randone B, Mal F, Basato S, Levard H, Gayet B (2013) Laparoscopic minor pancreatic resections (enucleations/atypical resections). A long-term appraisal of a supposed mini-invasive approach. Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques/kwartalnik pod patronatem Sekcji Wideochirurgii TChP oraz Sekcji Chirurgii Bariatrycznej TChP 8(2):117–129Google Scholar
  27. 27.
    Crippa S, Bassi C, Salvia R, Falconi M, Butturini G, Pederzoli P (2007) Enucleation of pancreatic neoplasms. Br J Surg 94(10):1254–1259CrossRefPubMedGoogle Scholar
  28. 28.
    Maire F, Ponsot P, Debove C, Dokmak S, Ruszniewski P, Sauvanet A (2015) Endoscopic management of pancreatic fistula after enucleation of pancreatic tumors. Surg Endosc 29(11):3112–3116CrossRefPubMedGoogle Scholar
  29. 29.
    Strobel O, Cherrez A, Hinz U, Mayer P, Kaiser J, Fritz S et al (2015) Risk of pancreatic fistula after enucleation of pancreatic tumours. Br J Surg 102(10):1258–1266CrossRefPubMedGoogle Scholar
  30. 30.
    Allard MA, Cunha AS, Gayet B, Adam R, Goere D, Bachellier P et al (2015) Early and long-term oncological outcomes after laparoscopic resection for colorectal liver metastases: a propensity score-based analysis. Ann Surg 262(5):794–802CrossRefPubMedGoogle Scholar
  31. 31.
    Cunha AS, Beau C, Rault A, Catargi B, Collet D, Masson B (2007) Laparoscopic versus open approach for solitary insulinoma. Surg Endosc 21(1):103–108CrossRefGoogle Scholar
  32. 32.
    Heeger K, Falconi M, Partelli S, Waldmann J, Crippa S, Fendrich V et al (2014) Increased rate of clinically relevant pancreatic fistula after deep enucleation of small pancreatic tumors. Langenbeck’s archives of surgery/Deutsche Gesellschaft fur Chirurgie 399(3):315–321CrossRefGoogle Scholar
  33. 33.
    Hüttner FJ, Koessler-Ebs J, Hackert T, Ulrich A, Buchler MW, Diener MK (2015) Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms. Br J Surg 102(9):1026–1036CrossRefPubMedGoogle Scholar
  34. 34.
    Faitot F, Gaujoux S, Barbier L, Novaes M, Dokmak S, Aussilhou B et al (2015) Reappraisal of pancreatic enucleations: a single-center experience of 126 procedures. Surgery 158(1):201–210CrossRefPubMedGoogle Scholar
  35. 35.
    Pitt SC, Pitt HA, Baker MS, Christians K, Touzios JG, Kiely JM et al (2009) Small pancreatic and periampullary neuroendocrine tumors: resect or enucleate? J Gastrointest Surg 13(9):1692–1698CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Mushegh A. Sahakyan
    • 1
    • 2
    • 3
    Email author
  • Bård Ingvald Røsok
    • 4
  • Airazat M. Kazaryan
    • 1
    • 5
  • Leonid Barkhatov
    • 1
    • 2
  • Sven-Petter Haugvik
    • 2
    • 6
  • Åsmund Avdem Fretland
    • 1
    • 2
    • 5
  • Dejan Ignjatovic
    • 5
  • Knut Jørgen Labori
    • 4
  • Bjørn Edwin
    • 1
    • 2
    • 4
  1. 1.The Intervention CentreOslo University Hospital - RikshospitaletOsloNorway
  2. 2.Institute of Clinical Medicine, Medical FacultyUniversity of OsloOsloNorway
  3. 3.Department of Surgery No 1Yerevan State Medical University After M. HeratsiYerevanArmenia
  4. 4.Department of HPB SugeryOslo University Hospital - RikshospitaletOsloNorway
  5. 5.Department of Digestive SurgeryAkershus University Hospital, University of OsloLørenskogNorway
  6. 6.Department of SurgeryDrammen Hospital, Vestre Viken Hospital TrustDrammenNorway

Personalised recommendations