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Extended laparoscopic distal pancreatectomy for adenocarcinoma in the body and tail of the pancreas: a single-center experience

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Abstract

Purpose

Extended resection is required for pancreatic adenocarcinoma infiltrating adjacent organs and structures. The role of laparoscopy in this setting is unclear. In this study, the outcomes of extended laparoscopic distal pancreatectomy (ELDP) for pancreatic body/tail adenocarcinoma were examined.

Methods

Perioperative and oncologic data were analyzed in patients undergoing laparoscopic distal pancreatectomy (LDP) for adenocarcinoma at Oslo University Hospital. ELDP was defined as suggested by the International Study Group for Pancreatic Surgery. The outcomes of ELDP were compared to those following standard LDP (SLDP).

Results

From August 2001 to June 2016, 460 consecutive patients underwent LDP for pancreatic neoplasms including 116 (25%) adenocarcinoma. SLDP and ELDP were applied in 78 and 31 patients, respectively. The adrenal gland (33%) and colon (21%) were the most frequently resected organs during ELDP. The latter was associated with larger tumor size (5.5 vs 4 cm, p = 0.03), longer operative time (236 vs 158 min, p = 0.001) and higher conversion rate (16 vs 3%, p = 0.019) compared with SLDP. Morbidity and 90-day mortality were similar. Median follow-up was 18 months. In patients with ductal adenocarcinoma, ELDP (n = 22) was associated with significantly shorter recurrence-free and overall survival than SLDP (n = 59) (6.2 vs 9.6 months, p = 0.047 and 12.9 vs 27 months, p < 0.01, respectively).

Conclusion

Although technically challenging, ELDP is feasible in patients with adenocarcinoma providing acceptable surgical outcomes. ELDP for ductal adenocarcinoma is associated with worse prognosis than SLDP, while its potential benefits over palliative care deserve further scrutiny.

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Abbreviations

LDP:

Laparoscopic distal pancreatectomy

SLDP:

Standard laparoscopic distal pancreatectomy

ELDP:

Extended laparoscopic distal pancreatectomy

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Author information

Authors and Affiliations

  1. Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia

    Mushegh A. Sahakyan & Airazat M. Kazaryan

  2. The Intervention Center, Oslo University Hospital, Rikshospitalet, 0027, Oslo, Norway

    Mushegh A. Sahakyan, Airazat M. Kazaryan, Davit L. Aghayan & Bjørn Edwin

  3. Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway

    Dyre Kleive, Davit L. Aghayan, Dejan Ignjatovic & Bjørn Edwin

  4. Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Dyre Kleive, Knut Jørgen Labori, Bård Ingvald Røsok & Bjørn Edwin

  5. Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway

    Airazat M. Kazaryan

  6. Department of Faculty Surgery N2, I.M, Sechenov First Moscow State Medical University, Moscow, Russia

    Airazat M. Kazaryan

  7. Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway

    Dejan Ignjatovic

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  1. Mushegh A. Sahakyan
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  8. Bjørn Edwin
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Contributions

Study conception and design: M.A.S., K.J.L., B.I.R., B.E.; acquisition of data: M.A.S., D.K., A.M.K., D.L.A., D.I.; analysis and interpretation of data: M.A.S., D.K., K.J.L., B.E.; drafting of manuscript: M.A.S., B.E.; critical revision of manuscript: D.K., A.M.K., D.L.A., D.I., K.J.L., B.I.R.

Corresponding author

Correspondence to Mushegh A. Sahakyan.

Ethics declarations

The study was approved by the Institutional Data Protection Officer.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Sahakyan, M.A., Kleive, D., Kazaryan, A.M. et al. Extended laparoscopic distal pancreatectomy for adenocarcinoma in the body and tail of the pancreas: a single-center experience. Langenbecks Arch Surg 403, 941–948 (2018). https://doi.org/10.1007/s00423-018-1730-x

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