Laparoscopic pancreaticoduodenectomy for benign and malignant diseases

Dulucq, Jean-Louis; Wintringer, P.; Mahajna, Ahmad

doi:10.1007/s00464-005-0474-1

Cited by 170 publications

(132 citation statements)

References 24 publications

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“…Despite the known benefits of laparoscopy, the anatomic challenges, the inherent technical complexity of this operation and the difficulty of performing three major anastomoses have limited the widespread use of minimally invasive cal and reconstructive challenges previously mentioned. There are two general approaches to MIPD: a total laparoscopic approach (TLPD) where the anastomoses (pancreaticojejunostomy, hepaticojejunostomy, gastrojejunostomy) along with the resection are done intracorporeally; and the laparoscopic-assisted, or hybrid approach where the reconstruction is done through a small incision which is also used for specimen extraction [38,40,42,[44][45][46] .…”

Section: Minimally Invasive Pancreaticoduodenectomymentioning

confidence: 99%

“…Most MIPD series report low mortality rate [38][39][40][41][42][43][44][45][46] ; Gumbs et al [48] reviewed 285 cases and found the overall mortality was 2%. A more recent series reports a 100-d mortality rate of 5.7%, which is not significantly different than the mortality rate of 8.8% in the OPD group in the same series [35] .…”

Section: Post-operative Recoverymentioning

confidence: 99%

“…Cho et al [38] and Asbun and Stauffer [35] compared their MIPD to contemporary OPD, and found that the OPD group have similar rate of pancreatic fistula (3%-13%). Other complications reported include biliary leak (2.4%-7%) [38,40,41] , delayed gastric emptying (7%-9.1%) [38,44] , small bowel obstruction 6.2% [45] , intra-abdominal hemorrhage (5.3%) [40] , intra-abdominal abscess (2.4%-19.9%) [35,40] , wound infection (11.3%) [35] , pulmonary complications and DVT (2.4%-14.3%) [39,41] . The average length of stay for MIPD varies between 8 and 18 [35,[38][39][40][41]44,45] .…”

Section: Post-operative Recoverymentioning

confidence: 99%

“…Other complications reported include biliary leak (2.4%-7%) [38,40,41] , delayed gastric emptying (7%-9.1%) [38,44] , small bowel obstruction 6.2% [45] , intra-abdominal hemorrhage (5.3%) [40] , intra-abdominal abscess (2.4%-19.9%) [35,40] , wound infection (11.3%) [35] , pulmonary complications and DVT (2.4%-14.3%) [39,41] . The average length of stay for MIPD varies between 8 and 18 [35,[38][39][40][41]44,45] . Asbun et al [35] found that the length of stay is significantly shorter in MIPD group compared to OPD group (8 d vs 12.4 d), whereas Cho et al [38] did not (16.4 d vs 15.6 d) [38] .…”

Section: Post-operative Recoverymentioning

confidence: 99%

“…Once again, published series have highly selected patients without major vascular involvement and relatively small tumour sizes of 2.1-3 cm [40,41,[43][44][45] . Negative margins are achieved in 100% cases in these series which is far different from the typical R0 margin rate of 70%-80% in large trials of OPD [50] .…”

Section: Oncologic Outcomesmentioning

confidence: 99%

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Laparoscopic pancreatectomy: Indications and outcomes

Liang

Hameed

Jayaraman

2014

WJG

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The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and shortterm oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons' experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve. Key words: Laparoscopy; Distal pancreatectomy; Pancreaticoduodenectomy; Robotic pancreatectomy; Enucleation Core tip: This review discusses recent advances in laparoscopic distal pancreatectomy (LDP), minimally invasive pancreaticoduodenectomy (MIPD), and enucleation. Recent studies show that LDP have improved perioperative recovery and equivalent oncologic outcomes. Studies on MIPD demonstrate that it is safe in terms of intra-operative outcomes, post-operative recovery and early oncologic outcomes; however, it requires advanced laparoscopic skills. Laparoscopic enucleation has become the operation of choice for small benign tumours that are away from the main pancreatic duct, especially insulinomas. We also summarize key results in pre-operative, perioperative and post-operative outcomes from contemporary series comparing open and laparoscopic pancreatic resections in the tables.

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