Laparoscopic Distal Pancreatectomy in Pancreatic Cancer

Abstract

Laparoscopic surgery for benign disease is well established and becoming well accepted in clinical practice. However, there are still debates using laparoscopy in malignant disease of the pancreas. During recent decades, laparoscopic surgery has been applied in various types of malignancy, such as colorectal cancer, gastric cancer, and even hepatocellular carcinoma. Several well-designed randomized studies have shown equivalent outcomes after laparoscopic surgery for colorectal cancer. Recent randomized studies on gastric cancer have shown that laparoscopic surgery is not inferior to open surgery in the treatment of early stage of gastric cancer. There are also numerous studies on the effectiveness of laparoscopic surgery for hepatocellular carcinoma. However, the studies on laparoscopic surgery on pancreatic cancer are still scarce. And there is no randomized controlled trial comparing laparoscopic distal pancreatectomy versus open distal pancreatectomy for patients with pancreatic cancers. The plausible reasons for this paucity of study may be the relative small number of cases of resectable pancreatic cancer, technical difficulty of laparoscopic surgery, and cautious application of this procedure to malignant disease. Therefore, the laparoscopic surgery for pancreatic cancer is not yet well recommended in current situation. Even though the reports on the laparoscopic distal pancreatectomy are still scarce, most of the reports show that outcomes are similar to open surgery. These studies show that laparoscopic distal pancreatectomy is associated with shorter hospital stay than open distal pancreatectomy. However, the advantage in length of hospital stay is meaningful only after it is proved that laparoscopic operation is not inferior to open procedures oncologically (Table 26.1) [1].