Pancreatic Cancer pp 1157-1167 | Cite as

Laparoscopic Surgery for Pancreatic Neoplasms

  • Santiago Sánchez Cabús
  • Laureano Fernández-Cruz
Reference work entry


After 20 years since its introduction, the laparoscopic approach has shown to be safe and reproducible in the surgical treatment of lesions in the pancreas, with the added benefits of reduced intraoperative blood loss and a shorter hospital stay. These benefits have been equally reproduced with surgical treatment of patients with pancreatic neoplasms. In the case of localized lesions in the body or tail of the pancreas, laparoscopic surgical treatment has proved equally effective as conventional open surgery in the short term, obtaining equivalent results from the oncological point of view. As for the laparoscopic surgical treatment of pancreatic head injuries, there is still a lack of available scientific evidence, but reported data show similar results to conventional surgery. Anyway, more studies are still needed to demonstrate the real role of the laparoscopic approach in the surgical treatment of patients with malignancies of the pancreas.


Laparoscopic surgery Pancreatic surgery Pancreatic neoplasm Pancreatic ductal adenocarcinoma Pancreatic neuroendocrine tumor Distal pancreatectomy Pancreatoduodenectomy 


  1. 1.
    Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8(5):408–10.CrossRefGoogle Scholar
  2. 2.
    Cuschieri A. Laparoscopic surgery of the pancreas. J R Coll Surg Edinb. 1994;39(3):178–84.PubMedGoogle Scholar
  3. 3.
    Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G, Kössler-Ebs J, Müller-Stich BP, Büchler MW, Hackert T, Diener MK. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery. 2015;157(1):45–55.CrossRefGoogle Scholar
  4. 4.
    Beane JD, Pitt HA, Nakeeb A, Schmidt CM, House MG, Zyromski NJ, Howard TJ, Lillemoe KD. Splenic preserving distal pancreatectomy: does vessel preservation matter? J Am Coll Surg. 2011;212(4):651–7.CrossRefGoogle Scholar
  5. 5.
    Kristinsson SY, Gridley G, Hoover RN, Check D, Landgren O. Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. Haematologica. 2014;99(2):392–8.CrossRefGoogle Scholar
  6. 6.
    Fernández-Cruz L, Cosa R, Blanco L, Levi S, López-Boado M-A, Navarro S. Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg. 2007;11(12):1607–21; discussion 1621–2.CrossRefGoogle Scholar
  7. 7.
    Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg. 1988;123(5):550–3.CrossRefGoogle Scholar
  8. 8.
    Adam JP, Jacquin A, Laurent C, Collet D, Masson B, Fernández-Cruz L, Sa-Cunha A. Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique. JAMA Surg. 2013;148:246–52.CrossRefGoogle Scholar
  9. 9.
    Yoon Y-S, Lee KH, Han H-S, Cho JY, Ahn KS. Patency of splenic vessels after laparoscopic spleen and splenic vessel-preserving distal pancreatectomy. Br J Surg. 2009;96(6):633–40.CrossRefGoogle Scholar
  10. 10.
    Yoon Y-S, Lee KH, Han H-S, Cho JY, Ahn KS. Effects of laparoscopic versus open surgery on splenic vessel patency after spleen and splenic vessel-preserving distal pancreatectomy: a retrospective multicenter study. Surg Endosc. 2015;29(3):583–8.CrossRefGoogle Scholar
  11. 11.
    Sánchez-Cabús S, Adam J-P, Pittau G, Gelli M, Cunha AS. Laparoscopic left pancreatectomy: early results after 115 consecutive patients. Surg Endosc. 2016. (Epub ahead of print).
  12. 12.
    Sánchez-Cabús S, Pittau G, Gelli M, Adam J, Jacquin A, Laurent C, Cunha AS. Splenic preservation after laparoscopic left pancreatectomy is associated with less postoperative major complications. An analysis of 115 consecutive patients. J Pancreas. 2016;S1(1):241–8.Google Scholar
  13. 13.
    Goh BKP, Chan CY, Soh H-L, Lee SY, Cheow PC, Chow PKH, Ooi LLPJ, Chung AYF. A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy. Int J Med Robot. 2016. (Epub ahead of print).
  14. 14.
    Braga M, Ridolfi C, Balzano G, Castoldi R, Pecorelli N, Di Carlo V. Learning curve for laparoscopic distal pancreatectomy in a high-volume hospital. Updat Surg. 2012;64(3):179–83.CrossRefGoogle Scholar
  15. 15.
    Ricci C, Casadei R, Buscemi S, Taffurelli G, D’Ambra M, Pacilio CA, Minni F. Laparoscopic distal pancreatectomy: what factors are related to the learning curve? Surg Today. 2015;45(1):50–6.CrossRefGoogle Scholar
  16. 16.
    Braga M, Pecorelli N, Ferrari D, Balzano G, Zuliani W, Castoldi R. Results of 100 consecutive laparoscopic distal pancreatectomies: postoperative outcome, cost-benefit analysis, and quality of life assessment. Surg Endosc. 2015;29(7):1871–8.CrossRefGoogle Scholar
  17. 17.
    Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003;133(5):521–7.CrossRefGoogle Scholar
  18. 18.
    Song KB, Kim SC, Park JB, Kim YH, Jung YS, Kim MH, Lee SK, Seo DW, Lee SS, Park DH, Han DJ. Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection. Surg Endosc Other Interv Tech. 2011;25:3364–72.CrossRefGoogle Scholar
  19. 19.
    Abu Hilal M, Richardson JRC, de Rooij T, Dimovska E, Al-Saati H, Besselink MG. Laparoscopic radical “no-touch” left pancreatosplenectomy for pancreatic ductal adenocarcinoma: technique and results. Surg Endosc Other Interv Tech. 2015. (Epub ahead of print).
  20. 20.
    Sahakyan MA, Kazaryan AM, Rawashdeh M, Fuks D, Shmavonyan M, Haugvik SP, Labori KJ, Buanes T, Røsok BI, Ignjatovic D, Abu Hilal M, Gayet B, Kim SC, Edwin B. Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients. Surg Endosc. 2015;30(8):3409–18.CrossRefGoogle Scholar
  21. 21.
    Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RCG, Kim HJ, Ahmad S, Cho CS, Parikh A, Chu CK, Hamilton N, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley C, McMasters KM, Lillemoe KD. A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg. 2010;210(5):779–85, 786–7.CrossRefGoogle Scholar
  22. 22.
    Magge D, Gooding W, Choudry H, Steve SJ, Zureikat A, Krasinskas A, Daouadi M, KKW L, Hughes SJ, Zeh HJ, Moser AJ. Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma. JAMA Surg. 2013;148(6):525–31.CrossRefGoogle Scholar
  23. 23.
    Sharpe S, Talamonti M, Wang E, Bentrem D, Roggin K, Prinz R, Marsh R, Stocker S, Winchester D, Baker M. The laparoscopic approach to distal pancreatectomy for ductal adenocarcinoma results in shorter lengths of stay without compromising oncologic outcomes. Am J Surg. 2015;209(3):557–63.CrossRefGoogle Scholar
  24. 24.
    Shin SH, Kim SC, Song KB, Hwang DW, Lee JH, Lee D, Lee JW, Jun E, Park KM, Lee YJ. A comparative study of laparoscopic vs. open distal pancreatectomy for left-sided ductal adenocarcinoma: a propensity score-matched analysis. J Am Coll Surg. 2015;220(2):177–85.CrossRefGoogle Scholar
  25. 25.
    Stauffer JA, Coppola A, Mody K, Asbun HJ. Laparoscopic versus open distal pancreatectomy for pancreatic adenocarcinoma. World J Surg. 2016;40(6):1477–84.CrossRefGoogle Scholar
  26. 26.
    Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MGH, Davidson BR, van Laarhoven CJHM. Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst Rev. 2016;4:CD011391.PubMedGoogle Scholar
  27. 27.
    Fernández-Cruz L, Poves I, Pelegrina A, Burdío F, Sánchez-Cabus S, Grande L. Laparoscopic distal pancreatectomy for pancreatic tumors: does size matter? Dig Surg. 2016;33(4):290–8.CrossRefGoogle Scholar
  28. 28.
    De Rooij T, Jilesen AP, Boerma D, Bonsing BA, Bosscha K, Van Dam RM, Van Dieren S, Dijkgraaf MG, Van Eijck CH, Gerhards MF, Van Goor H, Van Der Harst E, De Hingh IH, Kazemier G, Klaase JM, Molenaar IQ, Nieveen Van Dijkum EJ, Patijn GA, Van Santvoort HC, Scheepers JJ, Van Der Schelling GP, Sieders E, Vogel JA, Busch OR, Besselink MG. A nationwide comparison of laparoscopic and open distal pancreatectomy for benign and malignant disease. J Am Coll Surg. 2015;220(3):263–70.CrossRefGoogle Scholar
  29. 29.
    Liao C-H, Wu Y-T, Liu Y-Y, Wang S-Y, Kang S-C, Yeh C-N, Yeh T-S. Systemic review of the feasibility and advantage of minimally invasive pancreaticoduodenectomy. World J Surg. 2016;40(5):1218–25.CrossRefGoogle Scholar
  30. 30.
    Doula C, Kostakis ID, Damaskos C, Machairas N, Vardakostas DV, Feretis T, Felekouras E. Comparison between minimally invasive and open pancreaticoduodenectomy. Surg Laparosc Endosc Percutan Tech. 2016;26(1):6–16.CrossRefGoogle Scholar
  31. 31.
    Wang M, Meng L, Cai Y, Li Y, Wang X, Zhang Z, Peng B. Learning curve for laparoscopic pancreaticoduodenectomy: a CUSUM analysis. J Gastrointest Surg. 2016;20(5):924–35.CrossRefGoogle Scholar
  32. 32.
    Adam MA, Choudhury K, Dinan MA, Reed SD, Scheri RP, Blazer DG, Roman SA, Sosa JA. Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7061 patients. Ann Surg. 2015;262(2):372–7.CrossRefGoogle Scholar
  33. 33.
    de Rooij T, Lu MZ, Steen MW, Gerhards MF, Dijkgraaf MG, Busch OR, Lips DJ, Festen S, Besselink MG. Dutch Pancreatic Cancer Group. Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg. 2016;264(2):257–67.CrossRefGoogle Scholar
  34. 34.
    Dokmak S, Ftériche FS, Aussilhou B, Bensafta Y, Lévy P, Ruszniewski P, Belghiti J, Sauvanet A. Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors. J Am Coll Surg. 2015;220(5):831–8.CrossRefGoogle Scholar
  35. 35.
    Haugvik S-P, Marangos IP, Røsok BI, Pomianowska E, Gladhaug IP, Mathisen O, Edwin B. Long-term outcome of laparoscopic surgery for pancreatic neuroendocrine tumors. World J Surg. 2013;37:582–90.CrossRefGoogle Scholar
  36. 36.
    Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg. 2014;19(1):189–94.CrossRefGoogle Scholar
  37. 37.
    Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg. 2014;260(4):633–40.CrossRefGoogle Scholar
  38. 38.
    Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor J. “Artery-first” approaches to pancreatoduodenectomy. Br J Surg. 2012;99(8):1027–35.CrossRefGoogle Scholar
  39. 39.
    Partensky C. Abord premier de l’artère mésentérique supérieure au cours de la duodénopancréatectomie céphalique. J Chir (Paris). 2008;145(6):598–600.CrossRefGoogle Scholar
  40. 40.
    Pittau G, Sànchez-Cabùs S, Laurenzi A, Gelli M, Cunha AS. Laparoscopic pancreaticoduodenectomy: right posterior superior mesenteric artery “first” approach. Ann Surg Oncol. 2015;S3:345–8.CrossRefGoogle Scholar
  41. 41.
    Mabrut J-Y, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre J-M, Boulez J, Baulieux J, Peix J-L, Gigot J-F. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery. 2005;137(6):597–605.CrossRefGoogle Scholar
  42. 42.
    Jensen RT, Cadiot G, Brandi ML, de Herder WW, Kaltsas G, Komminoth P, Scoazec J-Y, Salazar R, Sauvanet A, Kianmanesh R. ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. Neuroendocrinology. 2012;95(2):98–119.CrossRefGoogle Scholar
  43. 43.
    Klöppel G, Couvelard A, Perren A, Komminoth P, McNicol A-M, Nilsson O, Scarpa A, Scoazec J-Y, Wiedenmann B, Papotti M, Rindi G, Plöckinger U. ENETS consensus guidelines for the standards of care in neuroendocrine tumors: towards a standardized approach to the diagnosis of gastroenteropancreatic neuroendocrine tumors and their prognostic stratification. Neuroendocrinology. 2009;90(2):162–6.CrossRefGoogle Scholar
  44. 44.
    Plöckinger U, Wiedenmann B, de Herder WW. ENETS consensus guidelines for the standard of care in neuroendocrine tumors. Neuroendocrinology. 2009;90(2):159–61.CrossRefGoogle Scholar
  45. 45.
    Fernández-Cruz L, Pelegrina A. Cirugía del gastrinoma: Resultados inmediatos y a largo plazo. Cir Esp. 2015;93(6):390–5.CrossRefGoogle Scholar
  46. 46.
    Edil B, Ellison J, Cameron R, Venkat R, Pawlik M, Choti M. Even small pancreatic endocrine neoplasm have lymph node metastasis. Abstr Pancreas Club. 2011;Program page 55.Google Scholar
  47. 47.
    Fernández-Cruz L, Blanco L, Cosa R, Rendón H. Is laparoscopic resection adequate in patients with neuroendocrine pancreatic tumors? World J Surg. 2008;32:904–17.CrossRefGoogle Scholar
  48. 48.
    Fernández-Cruz L, Molina V, Vallejos R, Jiménez Chavarria E, López-Boado M-A, Ferrer J. Outcome after laparoscopic enucleation for non-functional neuroendocrine pancreatic tumours. HPB (Oxford). 2012;14(3):171–6.CrossRefGoogle Scholar
  49. 49.
    Drymousis P, Raptis D, Spalding D, Fernandez-Cruz L, Menon D, Breitenstein S, Davidson B, Frilling A. Laparoscopic versus open pancreas resection for pancreatic neuroendocrine tumours: a systematic review and meta-analysis. HPB (Oxford). 2014;16(5):397–406.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Santiago Sánchez Cabús
    • 1
    • 2
  • Laureano Fernández-Cruz
    • 2
  1. 1.Department of HPB Surgery and Transplantation, ICMDiMHospital Clínic de BarcelonaBarcelonaSpain
  2. 2.Universitat de BarcelonaBarcelonaSpain

Section editors and affiliations

  • James L. Abbruzzese
    • 1
  • Raul A. Urrutia
    • 2
  • John Neoptolemos
    • 3
  • Markus W. Büchler
    • 4
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.Mayo Clinic Cancer CenterMayo ClinicRochesterUSA
  3. 3.Division of Surgery and OncologyUniversity of LiverpoolLiverpoolUK
  4. 4.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany

Personalised recommendations