title: Minimally invasive surgical techniques for pancreatic cancer: ready for prime time?
abstract: BACKGROUND
  Minimally invasive surgical techniques for pancreatic cancer are being applied with increasing frequency. With support of the literature, the location of the tumor within the pancreas is the factor which determines if these techniques can be safely used routinely by pancreatic surgeons.
  
  
  METHODS
  Literature supporting minimally invasive techniques for all types of resections for pancreatic cancer was reviewed.
  
  
  RESULTS
  Multiple meta-analysis regarding laparoscopic distal pancreatectomy all support the routine use of laparoscopy for these lesions. There are several case series describing the safety and efficacious use of laparoscopy in pancreaticoduodenectomy, and results have been promising in these highly specialized centers.
  
  
  CONCLUSIONS
  The location of the tumor within the pancreas remains the most critical factor in the use of laparoscopy as the standard of care. Lesions in the body and tail, which are readily resected with a distal or subtotal pancreatectomy should be performed laparoscopically unless there is a clear reason why not to do so. Lesions in the head of the pancreas have been shown to be removed safely and effectively with laparoscopy. However, the technical skills necessary and the ability to teach these to trainees are the limiting factors to widespread use. Further series are necessary to assess if the laparoscopic approach to pancreaticoduodenectomy will play a similar role as the one it plays in the surgical treatment for distal lesions.
authors.affiliation: Division of General Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Mesleh
authors.forename: John A
authors.initials: JA
authors.lastname: Stauffer
authors.forename: Horacio J
authors.initials: HJ
authors.lastname: Asbun
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010166:Palliative Care; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*
keywords: distal pancreatectomy; laparoscopy; pancreatic cancer; pancreaticoduodenectomy