title: Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference.
abstract: Introduced more than 20 years ago, laparoscopic pancreatic surgery (LAPS) has not reached a uniform acceptance among HPB surgeons. As a result, there is no consensus regarding its use in patients with pancreatic neoplasms. This study, organized by the European Association for Endoscopic Surgery (EAES), aimed to develop consensus statements and clinical recommendations on the application of LAPS in these patients.
  
  
  
  An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreatic surgery. Each panelist performed a critical appraisal of the literature and prepared evidence-based statements assessed by other panelists during Delphi process. The statements were further discussed during a one-day face-to-face meeting followed by the second round of Delphi. Modified statements were presented at the plenary session of the 24th International Congress of the EAES in Amsterdam and in a web-based survey.
  
  
  
  LAPS included laparoscopic distal pancreatectomy (LDP), pancreatoduodenectomy (LPD), enucleation, central pancreatectomy, and ultrasound. In general, LAPS was found to be safe, especially in experienced hands, and also advantageous over an open approach in terms of intraoperative blood loss, postoperative recovery, and quality of life. Eighty-five percent or higher proportion of responders agreed with the majority (69.5%) of statements. However, the evidence is predominantly based on retrospective case-control studies and systematic reviews of these studies, clearly affected by selection bias. Furthermore, no randomized controlled trials (RCTs) have been published to date, although four RCTs are currently underway in Europe.
  
  
  
  LAPS is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. LDP is feasible and safe, performed in many centers, while LPD is limited to few centers. RCTs and registry studies are essential to proceed with the assessment of LAPS.
authors.affiliation: The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, 0027, Norway.|Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.|Department of Hepato-Pancreato-Billiary Sugery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Edwin
authors.affiliation: The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, 0027, Norway. sahakyan.mushegh@gmail.com.|Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. sahakyan.mushegh@gmail.com.
authors.forename: Mushegh A
authors.initials: MA
authors.lastname: Sahakyan
authors.affiliation: University Hospital Southampton, NHS Foundation Trust, Southampton, UK.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abu Hilal
authors.affiliation: Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Department of Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
authors.affiliation: Department of Digestive Surgery, Hospital Saint-Eloi, Montpellier, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Fabre
authors.affiliation: Department of Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Laureano
authors.initials: L
authors.lastname: Fernández-Cruz
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.|Institut des Systèmes Intelligents et Robotique (ISIR), Université Pierre et Marie Curie, Paris, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
authors.affiliation: Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
authors.forename: Song Cheol
authors.initials: SC
authors.lastname: Kim
authors.affiliation: Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia.|Faculty of Surgery No. 2, Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: Igor E
authors.initials: IE
authors.lastname: Khatkov
mesh_terms: D003697:Delphi Technique; D005060:Europe; D006801:Humans; D010535:Laparoscopy; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012955:Societies, Medical
keywords: Consensus; Enucleation; Laparoscopy; Pancreatectomy; Pancreatoduodenectomy