Abstract
Background
Laparoscopy still is not universally accepted as an alternative approach for pancreatoduodenectomy. This study aimed to assess the feasibility and safety of laparoscopic pancreatoduodenectomy for benign and malignant lesions of the pancreas, and to examine whether this procedure obtains adequate margins and follows oncologic principles. To the best of the authors’ knowledge, their series of laparoscopic pancreatoduodenectomies is the largest reported to date.
Methods
A prospective study of laparoscopic pancreatoduodenectomy was undertaken between March 1999 and June 2005. The study enrolled 25 patients (16 women and 9 men) with a mean age of 62 ± 14 years. All the operations were performed in a single institution.
Results
The operations were performed without serious complications. Three patients underwent conversion to open surgery. For 13 patients, the anastomosis was performed intracorporeally. For the remaining 9 patients, the resection was performed laparoscopically, with the reconstruction performed through a small midline incision. There was no intraoperative mortality. The mean operating time was 287 ± 39 min, and the mean blood loss was 107 ± 48 ml. The mean time to the first bowel movement was 6 ± 1.5 days, and the mean time to independent self-care was 4.8 ± 0.8 days. Seven patients experienced postoperative complications. One patient died of a cardiac event 3 days after uncomplicated surgery. The mean hospital stay was 16.2 ± 2.7 days. All resected margins were tumor free. The mean number of retrieved lymph nodes for the malignant lesions was 18 ± 5.
Conclusion:
Laparoscopic pancreatoduodenectomy for selected cases of benign and malignant lesions performed by highly skilled laparoscopic surgeons is feasible and safe. This method can obtain adequate margins and follow oncological principles. Larger series and longer follow-up periods are needed to establish the current results.
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References
Ammori BJ (2004) Laparoscopic hand-assisted pancreaticoduodenectomy: initial UK experience. Surg Endosc 18: 717–718
Barlehner E, Anders S, Schwetling R (2002) Laparoscopic resection of the left pancreas. Dig Surg 19: 507–510
Cuschieri A (1994) Laparoscopic surgery of the pancreas. J R Coll Surg Edinb 39: 178–184
Cuschieri A (1988) Laparoscopy for pancreatic cancer: does it benefit the patient? Eur J Surg Oncol 14: 41–44
Cuschieri A, Hall AW, Klark J (1978) Value of laparoscopy in the diagnosis and management of pancreatic cancer. Gut 19: 672–677
Cushieri SA, Jakimowicz JJ (1998) Laparoscopic pancreatic resections. Semin Laparosc Surg 5: 168–179
Fabre JM, Dulucq JL, Vacher C, Lemoine MC, Wintringer P, Nocca D, Burgel GS, Domergue J (2002) Is laparoscopic left pancreatic resection justified? Surg Endosc 16: 1358–1361
Gagner M, Pomp A (1997) Laparoscopic pancreatic resection: is it worthwhile? J Gastrointest Surg 1: 20–26
Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8: 408–410
Gagner M, Pomp A, Herrena MF, et al (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120: 1051–1054
Lacy AM, Garcia-Valdecasas JC, Delgado S, et al (2002) Laparoscopic-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomized trial. Lancet 359: 2224–2229
Masson B, Sa-cunha A, Laurent C, et al (2003) Laparoscopic pancreatectomy: report of 22 cases. Ann Chir 128: 452–456
Park A, Schawrtz R (1999) Laparoscopic pancreatic surgery. Am J Surg 177: 158–163
Park AE, Heniford BT (2002) Therapeutic laparoscopy of the pancreas. Ann Surg 236: 149–158
Patterson EJ, Gagner M, Salky B, et al (2001) Laparoscopic pancreatic resection: a single-institution experience of 19 patients. J Am Coll Surg 193: 281–287
Reyes CD, Weber KJ, Gagner M, et al (2001) Laparoscopic versus open gastrectomy: a retrospective review. Surg Endosc 15: 928–931
Rhodes M, Nathanson L (1995) Laparoscopic biliary and gastric bypass: a useful adjunct in the treatment of carcinoma of the pancreas. Gut 36: 778–780
Shimizu S, Uchiyama A, Mizumoto K, et al (2000) Laparoscopically assisted distal gastrectomy for early gastric cancer: is it superior to open surgery? Surg Endosc 14: 27–31
Spanknebel K, Conlon KC (2001) Advances in the surgical management of pancreatic cancer. Cancer J 7: 312–323
Sussman LA, Christie R, Whittle DE (1996) Laparoscopic excision of distal pancreas including insulinoma. Aust N Z J Surg 66: 414–416
Uyama I, Ogiwara H, Lida S, et al (1996) Laparoscopic minilaparotomy: pancreatoduodenectomy with lymphadenectomy using an abdominal wall-lift method. Surg Laparosc Endosc 6: 405–410
Vezakis A, Davides D, Larvin M, et al (1999) Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg Endosc 13: 26–29
Yeo CJ, Cameron JL, Lillemoe KD, et al. (2002) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: part 2. randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 236: 355–366
Yeo CJ, Cameron JL, Sohn TA, et al. (1999) Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg 229: 613–622
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The authors thank Dr. Mitkal Sharon for her valuable help in proofreading this article.
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Dulucq, J., Wintringer, P. & Mahajna, A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc 20, 1045–1050 (2006). https://doi.org/10.1007/s00464-005-0474-1
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DOI: https://doi.org/10.1007/s00464-005-0474-1