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Ten years of experience with resection of left-sided pancreatic ductal adenocarcinoma: evolution and initial experience to a laparoscopic approach

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Abstract

Background

With increasing laparoscopic experience, laparoscopic distal pancreatectomy with or without splenectomy is being regarded as a safe and effective treatment for benign and borderline malignant lesions of the pancreas; however, its application for left-sided pancreatic ductal adenocarcinoma (PDAC) is still debatable.

Methods

We analyzed patients who underwent conventional distal pancreatectomy with splenectomy (DPS) for distal pancreatic cancer at our institution. We have performed laparoscopic DPS partly based on radical antegrade modular pancreatosplenectomy (RAMPS) for well-selected left-sided PDAC since 2007. We compared laparoscopic DPS to conventional DPS according to various clinicopathologic factors.

Results

From January 1999 to December 2008, 45 patients underwent conventional DPS for resectable left-sided PDAC, and 18 needed combined adjacent organ resection for potential margin negative (R0) resection. The median survival of resected left-sided PDAC was 27.9 months with a 5-year survival of 28.9%. A small amount of intraoperative bleeding [≤760 ml Exp(β) = 6.312, p = 0.001] and R0 resection [Exp(β) = 4.349, p = 0.090] were the most significant prognostic factors. To achieve bloodless and R0 resection, the potential indication for laparoscopic DPS was suspicious pancreatic cancer confined to the pancreas that could be removed by DPS without resection of the adjacent organs. Five patients underwent laparoscopic/robot-assisted DPS for left-sided PDAC. Compared to conventional DPS, only the operation time (p = 0.011) and tumor size (p = 0.031) were significantly different, but other clinicopathologic variables were comparable. All patients still are alive. Four patients have lived without tumor recurrence (follow-up = 4–22 months), and only one experienced multiple liver metastasis and subsequent retroperitoneal local recurrence.

Conclusion

Laparoscopic/robot-assisted modified anterior RAMPS may be technically feasible for well-selected PDAC. The oncologic feasibility still remains to be determined due to limited experience.

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Acknowledgment

The authors give special thanks for the valuable contribution of Professors Kyung Sik Kim, Jin Sub Choi, and Byong Ro Kim in our department to the surgical experience of left-sided pancreatic cancer. Without their effort and devotion to margin-negative resection of pancreatic cancers, this study would not have been done. In addition, the authors are also grateful to Dong-Su Jang (Medical Illustrator, Medical Research Support Section, Yonsei Universtity College of Medicine, Seoul, Korea) for his help with the figures.

Disclosure

Drs. Chang Moo Kang, Dong Hyun Kim, and Woo Jung Lee have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea

    Chang Moo Kang, Dong Hyun Kim & Woo Jung Lee

  2. Clinic of Biliopancreas, Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea

    Chang Moo Kang, Dong Hyun Kim & Woo Jung Lee

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  1. Chang Moo Kang
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  2. Dong Hyun Kim
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Correspondence to Woo Jung Lee.

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Kang, C.M., Kim, D.H. & Lee, W.J. Ten years of experience with resection of left-sided pancreatic ductal adenocarcinoma: evolution and initial experience to a laparoscopic approach. Surg Endosc 24, 1533–1541 (2010). https://doi.org/10.1007/s00464-009-0806-7

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