title: Minimally invasive radical pancreatectomy for left-sided pancreatic cancer: current status and future perspectives.
abstract: Minimally invasive distal pancreatectomy with splenectomy has been regarded as a safe and effective treatment for benign and borderline malignant pancreatic lesions. However, its application for left-sided pancreatic cancer is still being debated. The clinical evidence for radical antegrade modular pancreatosplenectomy (RAMPS)-based minimally invasive approaches for left-sided pancreatic cancer was reviewed. Potential indications and surgical concepts for minimally invasive RAMPS were suggested. Despite the limited clinical evidence for minimally invasive distal pancreatectomy in left-sided pancreatic cancer, the currently available clinical evidence supports the use of laparoscopic distal pancreatectomy under oncologic principles in well-selected left sided pancreatic cancers. A pancreas-confined tumor with an intact fascia layer between the pancreas and left adrenal gland/kidney positioned more than 1 or 2 cm away from the celiac axis is thought to constitute a good condition for the use of margin-negative minimally invasive RAMPS. The use of minimally invasive (laparoscopic or robotic) anterior RAMPS is feasible and safe for margin-negative resection in well-selected left-sided pancreatic cancer. The oncologic feasibility of the procedure remains to be determined; however, the currently available interim results indicate that even oncologic outcomes will not be inferior to those of open radical distal pancreatosplenectomy.
authors.affiliation: Chang Moo Kang, Sung Hwan Lee, Woo Jung Lee, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Chang Moo
authors.initials: CM
authors.lastname: Kang
authors.affiliation: Chang Moo Kang, Sung Hwan Lee, Woo Jung Lee, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Chang Moo Kang, Sung Hwan Lee, Woo Jung Lee, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000639:trends; D018365:Neoplasm, Residual; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012371:Robotics / Q000639:trends; D013156:Splenectomy; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000639:trends; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Laparoscopic pancreatectomy, Robotic pancreatectomy; Pancreatic cancer