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Surgical Endoscopy

, Volume 31, Issue 5, pp 2023–2041 | Cite as

Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference

  • Bjørn Edwin
  • Mushegh A. SahakyanEmail author
  • Mohammad Abu Hilal
  • Marc G. Besselink
  • Marco Braga
  • Jean-Michel Fabre
  • Laureano Fernández-Cruz
  • Brice Gayet
  • Song Cheol Kim
  • Igor E. Khatkov
  • EAES Consensus Conference Study Group
Consensus Statement

Abstract

Background

Introduced more than 20 years ago, laparoscopic pancreatic surgery (LAPS) has not reached a uniform acceptance among HPB surgeons. As a result, there is no consensus regarding its use in patients with pancreatic neoplasms. This study, organized by the European Association for Endoscopic Surgery (EAES), aimed to develop consensus statements and clinical recommendations on the application of LAPS in these patients.

Methods

An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreatic surgery. Each panelist performed a critical appraisal of the literature and prepared evidence-based statements assessed by other panelists during Delphi process. The statements were further discussed during a one-day face-to-face meeting followed by the second round of Delphi. Modified statements were presented at the plenary session of the 24th International Congress of the EAES in Amsterdam and in a web-based survey.

Results

LAPS included laparoscopic distal pancreatectomy (LDP), pancreatoduodenectomy (LPD), enucleation, central pancreatectomy, and ultrasound. In general, LAPS was found to be safe, especially in experienced hands, and also advantageous over an open approach in terms of intraoperative blood loss, postoperative recovery, and quality of life. Eighty-five percent or higher proportion of responders agreed with the majority (69.5%) of statements. However, the evidence is predominantly based on retrospective case–control studies and systematic reviews of these studies, clearly affected by selection bias. Furthermore, no randomized controlled trials (RCTs) have been published to date, although four RCTs are currently underway in Europe.

Conclusions

LAPS is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. LDP is feasible and safe, performed in many centers, while LPD is limited to few centers. RCTs and registry studies are essential to proceed with the assessment of LAPS.

Keywords

Laparoscopy Pancreatoduodenectomy Pancreatectomy Enucleation Consensus 

Notes

Acknowledgements

The members of the EAES consensus conference study group are as follows:

Magomet E. Baichorov, MD1, Thijs De Rooij, BSc2, Cansu G. Genç, MD2, Sven-Petter Haugvik, MD, PhD3, Roman E. Izrailov, MD, PhD1, Arthur A. Khisamov, MD1, Santiago Sánchez-Cabús, MD, PhD4, Régis Souche, MD5, Jony Van Hilst, MD2.

1Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia.

2Department of surgery, Academic Medical Center, Amsterdam, the Netherlands.

3Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.

4Department of Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain.

5Department of Surgery and Liver Transplantation, Hopital Saint Eloi-Hopitaux Universitaires de Montpellier, Université de Montpellier, Montpellier, France.

Compliance with ethical standards

Disclosures

Drs. Bjørn Edwin, Mohammad Abu Hilal, Marco Braga, Jean-Michel Fabre, Laureano Fernandez-Cruz, Brice Gayet, Song Cheol Kim, Igor E. Khatkov and Mushegh A. Sahakyan have no conflicts of interest or financial ties to disclose. Dr. Marc G. Besselink is funded by Ethicon International.

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Copyright information

© European Association for Endoscopic Surgery (EAES) 2017

Authors and Affiliations

  • Bjørn Edwin
    • 1
    • 2
    • 3
  • Mushegh A. Sahakyan
    • 1
    • 2
    Email author
  • Mohammad Abu Hilal
    • 4
  • Marc G. Besselink
    • 5
  • Marco Braga
    • 6
  • Jean-Michel Fabre
    • 7
  • Laureano Fernández-Cruz
    • 8
  • Brice Gayet
    • 9
    • 10
  • Song Cheol Kim
    • 11
  • Igor E. Khatkov
    • 12
    • 13
  • EAES Consensus Conference Study Group
    • 2
  1. 1.The Intervention CentreOslo University HospitalOsloNorway
  2. 2.Institute of Clinical Medicine, Medical FacultyUniversity of OsloOsloNorway
  3. 3.Department of Hepato-Pancreato-Billiary SugeryOslo University HospitalOsloNorway
  4. 4.University Hospital Southampton, NHS Foundation TrustSouthamptonUK
  5. 5.Department of SurgeryAcademic Medical Center AmsterdamAmsterdamThe Netherlands
  6. 6.Department of Surgery, San Raffaele HospitalVita-Salute San Raffaele UniversityMilanItaly
  7. 7.Department of Digestive SurgeryHospital Saint-EloiMontpellierFrance
  8. 8.Department of Surgery, Hospital ClinicUniversity of BarcelonaBarcelonaSpain
  9. 9.Department of Digestive Diseases, Institut Mutualiste MontsourisUniversité Paris DescartesParisFrance
  10. 10.Institut des Systèmes Intelligents et Robotique (ISIR)Université Pierre et Marie CurieParisFrance
  11. 11.Division of Hepato-Biliary and Pancreatic Surgery, Department of SurgeryUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulSouth Korea
  12. 12.Department of SurgeryMoscow Clinical Scientific CenterMoscowRussia
  13. 13.Faculty of Surgery No. 2Moscow State University of Medicine and DentistryMoscowRussia

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