The role of laparoscopy in pancreatic surgery.
Carcinoma of the pancreas is extremely common, with a five-year mortality rate of about 95-99%. Radical surgery requires good technical skill and can cause complications and operative mortality, but should be avoided in patients with extrapancreatic involvement. Advances in dynamic spiral CT-scan have decreased the number of unnecessary laparotomies. VLS is indicated in cases of pancreatic mass deemed resectable or "doubtful" by CT-scan. Direct laparoscopic visualization can be combined with intraoperative laparoscopic ultrasonography (LUS), which has shown a positive predictive value of resectability of 91%. Laparoscopic pancreatoduodenectomy (LPD) shows a high rate of complications and should be performed by very well-trained surgeons. Laparoscopic distal pancreatectomy (LDP) with an "en bloc" splenectomy and spleen preservation should be performed.
Sperlongano
Pasquale
P
Department of Aenesthesiological, Surgical and Emergency Sciences, Second University of Naples, Italy. pasquale.sperlongano@unina2.it
Pisaniello
Donatella
D
Piatto
Alberto
A
Parmeggiani
Domenico
D
Sperlongano
Rossella
R
Avenia
Nicola
N
Barbarisi
Alfonso
A
Parmeggiani
Umberto
U
D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D009367:Neoplasm Staging; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications