title: Laparoscopic resection of pancreatic adenocarcinoma: dream or reality?
abstract: Laparoscopic pancreatic surgery is in its infancy despite initial procedures reported two decades ago. Both laparoscopic distal pancreatectomy (LDP) and laparoscopic pancreaticoduodenectomy (LPD) can be performed competently; however when minimally invasive surgical (MIS) approaches are implemented the indication is often benign or low-grade malignant pathologies. Nonetheless, LDP and LPD afford improved perioperative outcomes, similar to those observed when MIS is utilized for other purposes. This includes decreased blood loss, shorter length of hospital stay, reduced post-operative pain, and expedited time to functional recovery. What then is its role for resection of pancreatic adenocarcinoma? The biology of this aggressive cancer and the inherent challenge of pancreatic surgery have slowed MIS progress in this field. In general, the overall quality of evidence is low with a lack of randomized control trials, a preponderance of uncontrolled series, short follow-up intervals, and small sample sizes in the studies available. Available evidence compiles heterogeneous pathologic diagnoses and is limited by case-by-case follow-up, which makes extrapolation of results difficult. Nonetheless, short-term surrogate markers of oncologic success, such as margin status and lymph node harvest, are comparable to open procedures. Unfortunately disease recurrence and long-term survival data are lacking. In this review we explore the evidence available regarding laparoscopic resection of pancreatic adenocarcinoma, a promising approach for future widespread application.
authors.affiliation: Blaire Anderson, Shahzeer Karmali, Department of Surgery, University of Alberta, Edmonton, Alberta T6G 2B7, Canada.
authors.forename: Blaire
authors.initials: B
authors.lastname: Anderson
authors.affiliation: Blaire Anderson, Shahzeer Karmali, Department of Surgery, University of Alberta, Edmonton, Alberta T6G 2B7, Canada.
authors.forename: Shahzeer
authors.initials: S
authors.lastname: Karmali
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D009364:Neoplasm Recurrence, Local; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D065287:Robotic Surgical Procedures; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome
keywords: Adenocarcinoma; Laparoscopic distal pancreatectomy; Laparoscopic pancreaticoduodenectomy; Laparoscopic surgery; Pancreatic cancer