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Systematic Review of Minimally Invasive Pancreatic Resection

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Pancreatic resection is associated with a significant morbidity. Efforts to reduce hospital stay and enhance recovery have seen the introduction of minimally invasive surgical techniques. This article reviews the current published literature on the safety and efficacy of minimally invasive surgery of the pancreas.

Methods

An electronic search of the PubMed and Embase databases was performed from 1996 to May 2008 to identify all relevant publications; studies meeting predefined inclusion criteria were retrieved and analyzed using a standardized protocol. Data on the safety and efficacy of minimally invasive surgery of the pancreas were recorded and analyzed.

Results

Of 565 abstracts reviewed, 39 studies were identified as eligible for inclusion. There were 37 case series and two case control studies. Compared with open pancreatic surgery, minimally invasive pancreatic resection is similar in terms of morbidity and mortality. Blood loss and length of stay are decreased.

Conclusions

Laparoscopic distal pancreatic resection and enucleation of insulinoma appear to be safe procedures with reduced hospital stay, though morbidity remains significant. The evidence for laparoscopic pancreaticoduodenectomy is in its infancy, but the authors feel it is unlikely that many centers will achieve sufficient case load to make the introduction of minimally invasive resection feasible.

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References

  1. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226(3):248–257. discussion 257–260. doi:10.1097/00000658-199709000-00004.

    Article  PubMed  CAS  Google Scholar 

  2. Iacono C, Accordini S, Bortolasi L, Facci E, Zamboni G, Montresor E, Marinello PD, Serio G. Results of pancreaticoduodenectomy for pancreatic cancer: extended versus standard procedure. World J Surg 2002;26(11):1309–1314. doi:10.1007/s00268-002-5976-6.

    Article  PubMed  Google Scholar 

  3. Gazzaniga GM, Cappato S, Papadia F, Mori L, Filauro M. D1 versus D2 pancreatoduodenectomy in surgical therapy of pancreatic head cancer. Hepatogastroenterology 2001;48(41):1471–1478.

    PubMed  CAS  Google Scholar 

  4. Mimica Z, Pogorelic Z, Perko Z, Srsen D, Stipic R, Dujmovic D. Effect of surgical incision on pain and respiratory function after abdominal surgery: a randomized clinical trial. Hepatogastroenterology 2007;54(80):2216–2220.

    PubMed  Google Scholar 

  5. Buchanan GN, Malik A, Parvaiz A, Sheffield JP, Kennedy RH. Laparoscopic resection for colorectal cancer. Br J Surg 2008;95(7):893–902. doi:10.1002/bjs.6019.

    Article  PubMed  CAS  Google Scholar 

  6. Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev 2006;4:CD006231.

    PubMed  Google Scholar 

  7. Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J. Long-term outcome of laparoscopic surgery for colorectal cancer: A cochrane systematic review of randomised controlled trials. Cancer Treat Rev 2008;34(6):498–504.

    Article  PubMed  Google Scholar 

  8. Velanovich V. Case-control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg 2006;10(1):95–98. doi:10.1016/j.gassur.2005.08.009.

    Article  PubMed  Google Scholar 

  9. Misawa T, Shiba H, Usuba T, Nojiri T, Kitajima K, Uwagawa T, Toyama Y, Ishida Y, Ishii Y, Yanagisawa A, Kobayashi S, Yanaga K. Systemic inflammatory response syndrome after hand-assisted laparoscopic distal pancreatectomy. Surg Endosc 2007;21(8):1446–1449. doi:10.1007/s00464-006-9149-9.

    Article  PubMed  Google Scholar 

  10. Uranues S, Alimoglu O, Todoric B, Toprak N, Auer T, Rondon L, Sauseng G, Pfeifer J. Laparoscopic resection of the pancreatic tail with splenic preservation. Am J Surg 2006;192(2):257–261. doi:10.1016/j.amjsurg.2006.01.031.

    Article  PubMed  Google Scholar 

  11. Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 2005;137(6):597–605. doi:10.1016/j.surg.2005.02.002.

    Article  PubMed  Google Scholar 

  12. Gramatica L Jr, Herrera MF, Mercado-Luna A, Sierra M, Verasay G, Brunner N. Videolaparoscopic resection of insulinomas: experience in two institutions. World J Surg 2002;26(10):1297–1300. doi:10.1007/s00268-002-6711-z.

    Article  PubMed  Google Scholar 

  13. Berends FJ, Cuesta MA, Kazemier G, van Eijck CH, de Herder WW, van Muiswinkel JM, Bruining HA, Bonjer HJ. Laparoscopic detection and resection of insulinomas. Surgery 2000;128(3):386–391. doi:10.1067/msy.2000.107413.

    Article  PubMed  CAS  Google Scholar 

  14. Ayav A, Bresler L, Brunaud L, Boissel P. Laparoscopic approach for solitary insulinoma: a multicentre study. Langenbecks Arch Surg 2005;390(2):134–140. doi:10.1007/s00423-004-0526-3.

    Article  PubMed  CAS  Google Scholar 

  15. Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc 2006;20(7):1045–1050. doi:10.1007/s00464-005-0474-1.

    Article  PubMed  CAS  Google Scholar 

  16. Palanivelu C, Jani K, Senthilnathan P, Parthasarathi R, Rajapandian S, Madhankumar MV. Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg 2007;205(2):222–230. doi:10.1016/j.jamcollsurg.2007.04.004.

    Article  PubMed  Google Scholar 

  17. Lu B, Cai X, Lu W, Huang Y, Jin X. Laparoscopic pancreaticoduodenectomy to treat cancer of the ampulla of Vater. JSLS 2006;10(1):97–100.

    PubMed  Google Scholar 

  18. Gagner M, Pomp A. Laparoscopic pancreatic resection: Is it worthwhile? J Gastrointest Surg 1997;1(1):20–25. discussion 25-26. doi:10.1007/s11605-006-0005-y.

    Article  PubMed  CAS  Google Scholar 

  19. Edwin B, Mala T, Mathisen O, Gladhaug I, Buanes T, Lunde OC, Soreide O, Bergan A, Fosse E. Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg Endosc 2004;18(3):407–411. doi:10.1007/s00464-003-9007-y.

    Article  PubMed  CAS  Google Scholar 

  20. D’Angelica M, Are C, Jarnagin W, DeGregoris G, Coit D, Jaques D, Brennan M, Fong Y. Initial experience with hand-assisted laparoscopic distal pancreatectomy. Surg Endosc 2006;20(1):142–148. doi:10.1007/s00464-005-0209-3.

    Article  PubMed  Google Scholar 

  21. Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A. Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc 2005;19(8):1028–1034. doi:10.1007/s00464-004-2182-7.

    Article  PubMed  CAS  Google Scholar 

  22. Fernandez-Cruz L, Cosa R, Blanco L, Levi S, Lopez-Boado MA, Navarro S. Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg 2007;11(12):1607–1621. discussion 1621-1602. doi:10.1007/s11605-007-0266-0.

    Article  PubMed  Google Scholar 

  23. Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P. Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 2007;246(1):77–82. doi:10.1097/01.sla.0000258607.17194.2b.

    Article  PubMed  Google Scholar 

  24. Han HS, Min SK, Lee HK, Kim SW, Park YH. Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels for benign pancreas neoplasm. Surg Endosc 2005;19(10):1367–1369. doi:10.1007/s00464-004-8158-9.

    Article  PubMed  Google Scholar 

  25. Barlehner E, Anders S, Schwetling R. Laparoscopic resection of the left pancreas: technique and indication. Dig Surg 2002;19(6):507–510. doi:10.1159/000067606.

    Article  PubMed  CAS  Google Scholar 

  26. Tang CN, Tsui KK, Ha JP, Wong DC, Li MK. Laparoscopic distal pancreatectomy: a comparative study. Hepatogastroenterology 2007;54(73):265–271.

    PubMed  CAS  Google Scholar 

  27. Gurusamy K, Junnarkar S, Farouk M, Davidson BR. Meta-analysis of randomized controlled trials on the safety and effectiveness of day-case laparoscopic cholecystectomy. Br J Surg 2008;95(2):161–168. doi:10.1002/bjs.6105.

    Article  PubMed  CAS  Google Scholar 

  28. Karim-Kos HE, de Vries E, Soerjomataram I, Lemmens V, Siesling S, Coebergh JW. Recent trends of cancer in Europe: A combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. Eur J Cancer 2008;44(10):1345–1389. doi:10.1016/j.ejca.2007.12.015.

    Article  PubMed  Google Scholar 

  29. Stojadinovic A, Brooks A, Hoos A, Jaques DP, Conlon KC, Brennan MF. An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma. J Am Coll Surg 2003;196(6):954–964. doi:10.1016/S1072-7515(03)00010-3.

    Article  PubMed  Google Scholar 

  30. Karanicolas PJ, Davies E, Kunz R, Briel M, Koka HP, Payne DM, Smith SE, Hsu HP, Lin PW, Bloechle C, Paquet KJ, Guyatt GH. The pylorus: take it or leave it? Systematic review and meta-analysis of pylorus-preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer. Ann Surg Oncol 2007;14(6):1825–1834. doi:10.1245/s10434-006-9330-3.

    Article  PubMed  Google Scholar 

  31. Knaebel HP, Diener MK, Wente MN, Buchler MW, Seiler CM. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 2005;92(5):539–546. doi:10.1002/bjs.5000.

    Article  PubMed  CAS  Google Scholar 

  32. Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 1999;229(5):693–698. discussion 698-700. doi:10.1097/00000658-199905000-00012.

    Article  PubMed  CAS  Google Scholar 

  33. Sa Cunha A, Rault A, Beau C, Collet D, Masson B. Laparoscopic central pancreatectomy: single institution experience of 6 patients. Surgery 2007;142(3):405–409. doi:10.1016/j.surg.2007.01.035.

    Article  PubMed  Google Scholar 

  34. Johnson MA, Rajendran S, Balachandar TG, Kannan DG, Jeswanth S, Ravichandran P, Surendran R. Central pancreatectomy for benign pancreatic pathology/trauma: is it a reasonable pancreas-preserving conservative surgical strategy alternative to standard major pancreatic resection? ANZ J Surg 2006;76(11):987–995. doi:10.1111/j.1445-2197.2006.03916.x.

    Article  PubMed  Google Scholar 

  35. Efron DT, Lillemoe KD, Cameron JL, Yeo CJ. Central pancreatectomy with pancreaticogastrostomy for benign pancreatic pathology. J Gastrointest Surg 2004;8(5):532–538. doi:10.1016/j.gassur.2004.03.004.

    Article  PubMed  Google Scholar 

  36. Park BJ, Alexander HR, Libutti SK, Huang J, Royalty D, Skarulis MC, Jensen RT, Gorden P, Doppman JL, Shawker TH, Fraker DL, Norton JA, Bartlett DL. Operative management of islet-cell tumors arising in the head of the pancreas. Surgery 1998;124(6):1056–1061. discussion 1061-1052. doi:10.1067/msy.1998.92171.

    Article  PubMed  CAS  Google Scholar 

  37. Talamini MA, Moesinger R, Yeo CJ, Poulose B, Hruban RH, Cameron JL, Pitt HA. Cystadenomas of the pancreas: is enucleation an adequate operation? Ann Surg 1998;227(6):896–903. doi:10.1097/00000658-199806000-00013.

    Article  PubMed  CAS  Google Scholar 

  38. Corcione F, Marzano E, Cuccurullo D, Caracino V, Pirozzi F, Settembre A. Distal pancreas surgery: outcome for 19 cases managed with a laparoscopic approach. Surg Endosc 2006;20(11):1729–1732. doi:10.1007/s00464-005-0839-5.

    Article  PubMed  CAS  Google Scholar 

  39. Gagner M, Pomp A, Herrera MF. Early experience with laparoscopic resections of islet cell tumors. Surgery 1996;120(6):1051–1054. doi:10.1016/S0039-6060(96)80054-7.

    Article  PubMed  CAS  Google Scholar 

  40. Patterson EJ, Gagner M, Salky B, Inabnet WB, Brower S, Edye M, Gurland B, Reiner M, Pertsemlides D. Laparoscopic pancreatic resection: single-institution experience of 19 patients. J Am Coll Surg 2001;193(3):281–287. doi:10.1016/S1072-7515(01)01018-3.

    Article  PubMed  CAS  Google Scholar 

  41. Cuschieri A, Jakimowicz JJ, van Spreeuwel J. Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg 1996;223(3):280–285. doi:10.1097/00000658-199603000-00008.

    Article  PubMed  CAS  Google Scholar 

  42. Fernandez-Cruz L, Saenz A, Astudillo E, Pantoja JP, Uzcategui E, Navarro S. Laparoscopic pancreatic surgery in patients with chronic pancreatitis. Surg Endosc 2002;16(6):996–1003. doi:10.1007/s00464-001-9065-y.

    Article  PubMed  CAS  Google Scholar 

  43. Fabre JM, Dulucq JL, Vacher C, Lemoine MC, Wintringer P, Nocca D, Burgel JS, Domergue J. Is laparoscopic left pancreatic resection justified? Surg Endosc 2002;16(9):1358–1361. doi:10.1007/s00464-001-9206-3.

    Article  PubMed  CAS  Google Scholar 

  44. Misawa T, Shiba H, Usuba T, Nojiri T, Uwagawa T, Ishida Y, Ishii Y, Yanaga K. Safe and quick distal pancreatectomy using a staggered six-row stapler. Am J Surg 2008;195(1):115–118. doi:10.1016/j.amjsurg.2007.01.038.

    Article  PubMed  Google Scholar 

  45. Park AE, Heniford BT. Therapeutic laparoscopy of the pancreas. Ann Surg 2002;236(2):149–158. doi:10.1097/00000658-200208000-00002.

    Article  PubMed  Google Scholar 

  46. Vezakis A, Davides D, Larvin M, McMahon MJ. Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg Endosc 1999;13(1):26–29. doi:10.1007/s004649900891.

    Article  PubMed  CAS  Google Scholar 

  47. Velanovich V. The lasso technique for laparoscopic distal pancreatectomy. Surg Endosc 2006;20(11):1766–1771. doi:10.1007/s00464-004-8704-5.

    Article  PubMed  CAS  Google Scholar 

  48. Van Nieuwenhove Y, Vandaele S, Op de Beeck B, Delvaux G. Neuroendocrine tumors of the pancreas. Surg Endosc 2003;17(10):1658–1662. doi:10.1007/s00464-002-9268-x.

    Article  PubMed  Google Scholar 

  49. Toniato A, Meduri F, Foletto M, Avogaro A, Pelizzo M. Laparoscopic treatment of benign insulinomas localized in the body and tail of the pancreas: a single-center experience. World J Surg 2006;30(10):1916–1919. discussion 1920-1911. doi:10.1007/s00268-005-0645-1.

    Article  PubMed  Google Scholar 

  50. Shimizu S, Tanaka M, Konomi H, Mizumoto K, Yamaguchi K. Laparoscopic pancreatic surgery: current indications and surgical results. Surg Endosc 2004;18(3):402–406. doi:10.1007/s00464-003-8164-3.

    Article  PubMed  CAS  Google Scholar 

  51. Pierce RA, Spitler JA, Hawkins WG, Strasberg SM, Linehan DC, Halpin VJ, Eagon JC, Brunt LM, Frisella MM, Matthews BD. Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc 2007;21(4):579–586. doi:10.1007/s00464-006-9022-x.

    Article  PubMed  CAS  Google Scholar 

  52. Jaroszewski DE, Schlinkert RT, Thompson GB, Schlinkert DK. Laparoscopic localization and resection of insulinomas. Arch Surg 2004;139(3):270–274. doi:10.1001/archsurg.139.3.270.

    Article  PubMed  Google Scholar 

  53. Sweet MP, Izumisato Y, Way LW, Clark OH, Masharani U, Duh QY. Laparoscopic enucleation of insulinomas. Arch Surg 2007;142(12):1202–1204. discussion 1205. doi:10.1001/archsurg.142.12.1202.

    Article  PubMed  Google Scholar 

  54. Iihara M, Obara T. Recent advances in minimally invasive pancreatic surgery. Asian J Surg 2003;26(2):86–91.

    PubMed  Google Scholar 

  55. Liu H, Peng C, Zhang S, Wu Y, Fang H, Sheng H, Peng S. Strategy for the surgical management of insulinomas: analysis of 52 cases. Dig Surg 2007;24(6):463–470. doi:10.1159/000111822.

    Article  PubMed  CAS  Google Scholar 

  56. Schraibman V, Goldenberg A, de Matos Farah JF, Apodaca FR, Goldman S, Lobo EJ. Laparoscopic enucleation of pancreatic insulinomas. J Laparoendosc Adv Surg Tech A 2007;17(4):399–401. doi:10.1089/lap.2006.0110.

    Article  PubMed  Google Scholar 

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Conflict of interest

None declared.

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Authors and Affiliations

  1. Cancer Biomarkers and Prevention Group, Department of Cancer Studies and Molecular Medicine, Bio centre, University of Leicester, University Road, Leicester, LE1 7RH, UK

    Christopher D. Briggs, Christopher D. Mann, Christopher P. Neal & David P. Berry

  2. Department of Hepatobiliary and Pancreatic Surgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF, UK

    Glen R. B. Irving, Mark Peterson & Iain C. Cameron

  3. Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK

    David P. Berry

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  1. Christopher D. Briggs
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  2. Christopher D. Mann
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Correspondence to Christopher D. Briggs.

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Briggs, C.D., Mann, C.D., Irving, G.R.B. et al. Systematic Review of Minimally Invasive Pancreatic Resection. J Gastrointest Surg 13, 1129–1137 (2009). https://doi.org/10.1007/s11605-008-0797-z

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  • DOI: https://doi.org/10.1007/s11605-008-0797-z

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