Abstract
Background
Experience with laparoscopic resection of pancreatic neoplasms remains limited. The purpose of this study is to critically analyze the indications for and outcomes after laparoscopic resection of pancreatic neoplasms.
Methods
The medical records of all patients undergoing laparoscopic resection of pancreatic neoplasms from July 2000 to February 2006 were reviewed. Data are expressed as mean ± standard deviation.
Results
Laparoscopic pancreatic resection was performed in 22 patients (M:F, 8:14) with a mean age of 56.3 ± 15.1 years and mean body mass index (BMI) of 26.3 ± 4.5 kg/m2. Nine patients had undergone previous intra-abdominal surgery. Indications for pancreatic resection were cyst (1), glucagonoma (1), gastrinoma (2), insulinoma (3), metastatic tumor (2), IPMT (4), nonfunctioning neuroendocrine tumor (3), and mucinous/serous cystadenoma (6). Mean tumor size was 2.4 ± 1.6 cm. Laparoscopic distal pancreatectomy was attempted in 18 patients and completed in 17, and enucleation was performed in 4 patients. Laparoscopic ultrasound (n = 10) and a hand-assisted technique (n = 4) were utilized selectively. Mean operative time was 236 ± 60 min and mean blood loss was 244 ± 516 ml. There was one conversion to an open procedure because of bleeding from the splenic vein. The mean postoperative LOS was 4.5 ± 2.0 days. Seven patients experienced a total of ten postoperative complications, including a urinary tract infection (UTI) (1), lower-extremity deep venous thrombosis (DVT) and pulmonary embolus (1), infected peripancreatic fluid collection (1), pancreatic pseudocyst (1), and pancreatic fistula (6). Five pancreatic fistulas were managed by percutaneous drainage. The reoperation rate was 4.5% and the overall pancreatic-related complication rate was 36.4%. One patient developed pancreatitis and a pseudocyst 5 months postoperatively, which was managed successfully with a pancreatic duct stent. There was no 30-day mortality.
Conclusions
Laparoscopic pancreatic resection is safe and feasible in selected patients with pancreatic neoplasms. With a pancreatic duct leak rate of 27%, this problem remains an area of development for the minimally invasive technique.
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References
Ammori BJ (2003) Pancreatic surgery in the laparoscopic era. JOP 4: 187–192
Assalia A, Gagner M (2004) Laparoscopic pancreatic surgery for islet cell tumors of the pancreas. World J Surg 28: 1239–1247
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138: 8–13
Berends FJ, Cuesta MA, Kazemier G, van Eijck CH, de Herder WW, van Muiswinkel JM, Bruining HA, Bonjer HJ (2000) Laparoscopic detection and resection of insulinomas. Surgery 128: 386–391
Conlon KC, Labow D, Leung D, Smith A, Jarnagin W, Coit DG, Merchant N, Brennan MF (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234: 487–493
Cuschieri SA, Jakimowicz JJ, Stultiens G (1998) Laparoscopic infracolic approach for complications of acute pancreatitis. Semin Laparosc Surg 5: 189–194
D’Angelica M, Fong Y, Weber S, Gonen M, DeMatteo RP, Conlon K, Blumgart LH, Jarnagin WR (2003) The role of staging laparoscopy in hepatobiliary malignancy: prospective analysis of 401 cases. Ann Surg Oncol 10: 183–189
Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A (2005) Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc 19: 1028–1034
Edwin B, Mala T, Mathisen O, Gladhaug I, Buanes T, Lunde OC, Soreide O, Bergan A, Fosse E (2004) Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg Endosc 18: 407–411
Fagniez PL, Munoz-Bongrand N (1999) Vascular control during left splenopancreatectomy in cancer. Ann Chir 53: 632–634
Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8: 408–410
Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120: 1051–1054
Kajiyama Y, Tsurumaru M, Udagawa H, Tsutsumi K, Kinoshita Y, Akiyama H (1996) Quick and simple distal pancreatectomy using the GIA stapler: report of 35 cases. Br J Surg 83: 1711
Knaebel HP, Diener MK, Wente MN, Buchler MW, Seiler CM (2005) Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 92: 539–546
Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229: 693–698
Lin JW, Cameron JL, Yeo CJ, Riall TS, Lillemoe KD (2004) Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg 8: 951–959
Lo CY, Chan WF, Lo CM, Fan ST, Tam PK (2004) Surgical treatment of pancreatic insulinomas in the era of laparoscopy. Surg Endosc 18: 297–302
Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137: 597–605
Maire F, Sauvanet A, Trivin F, Hammel P, O’Toole D, Palazzo L, Vilgrain V, Belghiti J, Ruszniewski P, Levy P (2004) Staging of pancreatic head adenocarcinoma with spiral CT and endoscopic ultrasonography: an indirect evaluation of the usefulness of laparoscopy. Pancreatology 4: 436–440
Park AE, Heniford BT (2002) Therapeutic laparoscopy of the pancreas. Ann Surg 236: 149–158
Shankar S, Theis B, Russell RC (1990) Management of the stump of the pancreas after distal pancreatic resection. Br J Surg 77: 541–544
Shimizu S, Tanaka M, Konomi H, Mizumoto K, Yamaguchi K (2004) Laparoscopic pancreatic surgery: current indications and surgical results. Surg Endosc 18: 402–406
Strasberg SM, Drebin JA, Linehan D (2003) Radical antegrade modular pancreatosplenectomy. Surgery 133: 521–527
Sussman LA, Christie R, Whittle DE, Sussman LA, Christie R, Whittle DE (1996) Laparoscopic excision of distal pancreas including insulinoma. ANZ J Surg 66: 414–416
Takeuchi K, Tsuzuki Y, Ando T, Sekihara M, Hara T, Kori T, Nakajima H, Kuwano H (2003) Distal pancreatectomy: is staple closure beneficial? Aust N Z J Surg 73: 922–925
Underwood RA, Soper NJ (1999) Current status of laparoscopic surgery of the pancreas. J Hepatobiliary Pancreat Surg 6: 154–164
Uyama I, Ogiwara H, Iida S, Takahara T, Furuta T, Kikuchi K (1996) Laparoscopic minilaparotomy pancreaticoduodenectomy with lymphadenectomy using an abdominal wall-lift method. Surg Laparosc Endosc 6: 405–410
Vezakis A, Davides D, Larvin M, McMahon MJ (1999) Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg Endosc 13: 26–29
Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123: 550–553
Yeo CJ, Cameron JL, Maher MM, Sauter PK, Zahurak ML, Talamini MA, Lillemoe KD, Pitt HA (1995) A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 222: 580–588
Zhao ZW, He JY, Tan G, Wang HJ, Li KJ (2003) Laparoscopy and laparoscopic ultrasonography in judging the resectability of pancreatic head cancer. Hepatobiliary Pancreat Dis Int 2: 609–611
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Appendix: Results of Initial Literature Search
Appendix: Results of Initial Literature Search
-
1.
Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137: 597–605
-
2.
Barlehner E, Anders S, Schwetling R (2002) Laparoscopic resection of the left pancreas: technique and indication. Dig Surg 19: 507–510
-
3.
Fernandez-Cruz L, Saenz A, Astudillo E, Pantoja JP, Uzcategui E, Navarro S (2002) Laparoscopic pancreatic surgery in patients with chronic pancreatitis. Surg Endosc 16: 996–1003
-
4.
Fernandez-Cruz L, Herrera M, Saenz A, Pantoja JP, Astudillo E, Sierra M (2001) Laparoscopic pancreatic surgery in patients with neuroendocrine tumours: indications and limits. Baillieres Best Pract Res Clin Endocrinol Metab 15: 161–175
-
5.
Berends FJ, Cuesta MA, Kazemier G, van Eijck CH, de Herder WW, van Muiswinkel JM, Bruining HA, Bonjer HJ (2000) Laparoscopic detection and resection of insulinomas. Surgery 128: 386–391
-
6.
Spitz JD, Lilly MC, Tetik C, Arregui ME (2000) Ultrasound-guided laparoscopic resection of pancreatic islet cell tumors. Surg Laparosc Endosc Percutan Tech 10: 168–173
-
7.
Vezakis A, Davides D, Larvin M, McMahon MJ (1999) Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg Endosc 13: 26–29
-
8.
Van NY, Delvaux G (1999) Laparoscopic management of neuroendocrine tumours of the pancreas. Acta Chir Belg 99: 249–252
-
9.
Cuschieri SA, Jakimowicz JJ, Stultiens G (1998) Laparoscopic infracolic approach for complications of acute pancreatitis. Semin Laparosc Surg 5: 189–194
-
10.
Sussman LA, Christie R, Whittle DE (1996) Laparoscopic excision of distal pancreas including insulinoma. Aust N Z J Surg 66: 414–416
-
11.
Minni F, Marrano N, Pasquali R (2003) Laparoscopic body-tail pancreatic resection for insulinoma. Surg Endosc 17: 159–160
-
12.
Ammori BJ (2002) Laparoscopic transgastric pancreatic necrosectomy for infected pancreatic necrosis. Surg Endosc 16: 1362
-
13.
Sayad P, Cacchione R, Ferzli G (2001) Laparoscopic distal pancreatectomy for blunt injury to the pancreas. A case report. Surg Endosc 15: 759
-
14.
Alverdy J, Vargish T, Desai T, Frawley B, Rosen B (2000) Laparoscopic intracavitary debridement of peripancreatic necrosis: preliminary report and description of the technique. Surgery 127: 112–114
-
15.
Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A (2005) Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc 19: 1028–1034
-
16.
Edwin B, Mala T, Mathisen O, Gladhaug I, Buanes T, Lunde OC, Soreide O, Bergan A, Fosse E (2004) Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg Endosc 18: 407–411
-
17.
Shimizu S, Tanaka M, Konomi H, Mizumoto K, Yamaguchi K (2004) Laparoscopic pancreatic surgery: current indications and surgical results. Surg Endosc 18: 402–406
-
18.
Assalia A, Gagner M (2004) Laparoscopic pancreatic surgery for islet cell tumors of the pancreas. World J Surg 28: 1239–1247
-
19.
Lo CY, Chan WF, Lo CM, Fan ST, Tam PK (2004) Surgical treatment of pancreatic insulinomas in the era of laparoscopy. Surg Endosc 18: 297–302
-
20.
Park AE, Heniford BT (2002) Therapeutic laparoscopy of the pancreas. Ann Surg 236: 149–158
-
21.
Gramatica L Jr, Herrera MF, Mercado-Luna A, Sierra M, Verasay G, Brunner N (2002) Videolaparoscopic resection of insulinomas: experience in two institutions. World J Surg 26: 1297–1300
-
22.
Tagaya N, Kasama K, Suzuki N, Taketsuka S, Horie K, Furihata M, Kubota K (2003) Laparoscopic resection of the pancreas and review of the literature. Surg Endosc 17: 201–206
-
23.
Fabre JM, Dulucq JL, Vacher C, Lemoine MC, Wintringer P, Nocca D, Burgel JS, Domergue J (2002) Is laparoscopic left pancreatic resection justified? Surg Endosc 16: 1358–1361
-
24.
Patterson EJ, Gagner M, Salky B, Inabnet WB, Brower S, Edye M, Gurland B, Reiner M, Pertsemlides D (2001) Laparoscopic pancreatic resection: single-institution experience of 19 patients. J Am Coll Surg 193: 281–287
-
25.
Mahon D, Allen E, Rhodes M (2002) Laparoscopic distal pancreatectomy. Three cases of insulinoma. Surg Endosc 16: 700–702
-
26.
Iihara M, Kanbe M, Okamoto T, Ito Y, Obara T (2001) Laparoscopic ultrasonography for resection of insulinomas. Surgery 130: 1086–1091
-
27.
Lo CY, Lo CM, Fan ST (2000) Role of laparoscopic ultrasonography in intraoperative localization of pancreatic insulinoma. Surg Endosc 14: 1131–1135
-
28.
Cuschieri A, Jakimowicz JJ, van SJ (1996) Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg 223: 280–285
-
29.
Ammori BJ (2004) Laparoscopic hand-assisted pancreaticoduodenectomy: initial UK experience. Surg Endosc 18: 717–718
-
30.
Rosen M, Zuccaro G, Brody F (2003) Laparoscopic resection of a periampullary villous adenoma. Surg Endosc 17: 1322–1323
-
31.
Goletti O, Celona G, Monzani F, Caraccio N, Zocco G, Lippolis PV, Battini A, Seccia M, Cavina E (2003) Laparoscopic treatment of pancreatic insulinoma. Surg Endosc 17: 1499
-
32.
Takamatsu S, Teramoto K, Inoue H, Goseki N, Takahashi S, Baba H, Iwai T, Arii S (2002) Laparoscopic enucleation of an insulinoma of the pancreas tail. Surg Endosc 16: 217
-
33.
Tagaya N, Ishikawa K, Kubota K (2002) Spleen-preserving laparoscopic distal pancreatectomy with conservation of the splenic artery and vein for a large insulinoma. Surg Endosc 16: 217–218
-
34.
Shinchi H, Takao S, Noma H, Mataki Y, Iino S, Aikou T (2001) Hand-assisted laparoscopic distal pancreatectomy with minilaparotomy for distal pancreatic cystadenoma. Surg Laparosc Endosc Percutan Tech 11: 139–143
-
35.
Furihata M, Tagaya N, Kubota K (2001) Laparoscopic enucleation of insulinoma in the pancreas: case report and review of the literature. Surg Laparosc Endosc Percutan Tech 11: 279–283
-
36.
Dexter SP, Martin IG, Leindler L, Fowler R, McMahon MJ (1999) Laparoscopic enucleation of a solitary pancreatic insulinoma. Surg Endosc 13: 406–408
-
37.
Matsumoto T, Kitano S, Yoshida T, Bandoh T, Kakisako K, Ninomiya K, Tsuboi S, Baatar D (1999) Laparoscopic resection of a pancreatic mucinous cystadenoma using laparosonic coagulating shears. Surg Endosc 13: 172–173
-
38.
Klingler PJ, Hinder RA, Menke DM, Smith SL (1998) Hand-assisted laparoscopic distal pancreatectomy for pancreatic cystadenoma. Surg Laparosc Endosc 8: 180–184
-
39.
Chapuis Y, Bigourdan JM, Massault PP, Pitre J, Palazzo L (1998) Videolaparoscopic excision of insulinoma. A study of 5 cases. Chirurgie 123: 461–467
-
40.
Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120: 1051–1054
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Pierce, R.A., Spitler, J.A., Hawkins, W.G. et al. Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc 21, 579–586 (2007). https://doi.org/10.1007/s00464-006-9022-x
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DOI: https://doi.org/10.1007/s00464-006-9022-x