Skip to main content
Top
Published in: Medical Oncology 7/2017

Open Access 01-07-2017 | Review Article

Minimally invasive pancreatic cancer surgery: What is the current evidence?

Authors: Michał Pędziwiatr, Piotr Małczak, Piotr Major, Jan Witowski, Beata Kuśnierz-Cabala, Piotr Ceranowicz, Andrzej Budzyński

Published in: Medical Oncology | Issue 7/2017

Login to get access

Abstract

Surgery remains the only option to cure pancreatic cancer. Although the use of laparoscopy in oncology is rapidly growing worldwide, its efficacy in pancreatic surgery remains controversial. A number of studies have compared outcomes of minimally invasive and open pancreatic resections. However, they are mostly non-randomized trials including relatively small groups of patients. In addition, most of these studies were conducted in high-volume pancreatic centres. It seems that despite longer operative time, laparoscopy may be beneficial in terms of morbidity, blood loss and hospital stay. Thus far, very little is known about the long-term outcomes of laparoscopic surgery for pancreatic cancer. Our aim was to review current evidence for the use of minimally invasive techniques in patients with pancreatic malignancy.
Literature
1.
2.
go back to reference Butturini G. Influence of resection margins and treatment on survival in patients with pancreatic cancer. Arch Surg. 2008;143:75–83.CrossRefPubMed Butturini G. Influence of resection margins and treatment on survival in patients with pancreatic cancer. Arch Surg. 2008;143:75–83.CrossRefPubMed
3.
go back to reference Tumas J, Kvederaviciute K, Petrulionis M, Kurlinkus B, Rimkus A, Sakalauskaite G, et al. Metabolomics in pancreatic cancer biomarkers research. Med Oncol. 2016;33:133.CrossRefPubMed Tumas J, Kvederaviciute K, Petrulionis M, Kurlinkus B, Rimkus A, Sakalauskaite G, et al. Metabolomics in pancreatic cancer biomarkers research. Med Oncol. 2016;33:133.CrossRefPubMed
4.
go back to reference Ferlay J, Partensky C, Bray F. More deaths from pancreatic cancer than breast cancer in the EU by 2017. Acta Oncol. 2016;55:1158–60.CrossRefPubMed Ferlay J, Partensky C, Bray F. More deaths from pancreatic cancer than breast cancer in the EU by 2017. Acta Oncol. 2016;55:1158–60.CrossRefPubMed
5.
go back to reference Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017;389:1011–24.CrossRefPubMed Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017;389:1011–24.CrossRefPubMed
6.
go back to reference Kausch W. Das Carcinom der papilla duodeni und seine radikale Entfernung. Beitrage zur Klinischen Chirurgie. 1912;78:439–86. Kausch W. Das Carcinom der papilla duodeni und seine radikale Entfernung. Beitrage zur Klinischen Chirurgie. 1912;78:439–86.
8.
go back to reference Adam MA, Choudhury K, Dinan MA, Reed SD, Scheri RP, Blazer DGI, et al. Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7061 Patients. Ann Surg. 2015;262:372–7.CrossRefPubMed Adam MA, Choudhury K, Dinan MA, Reed SD, Scheri RP, Blazer DGI, et al. Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7061 Patients. Ann Surg. 2015;262:372–7.CrossRefPubMed
9.
go back to reference Witzigmann H, Diener MK, Kienkötter S, Rossion I, Bruckner T, Werner Bärbel, et al. No need for routine drainage after pancreatic head resection: the dual-center, randomized, controlled PANDRA trial (ISRCTN04937707). Ann Surg. 2016;264:528–37.CrossRefPubMed Witzigmann H, Diener MK, Kienkötter S, Rossion I, Bruckner T, Werner Bärbel, et al. No need for routine drainage after pancreatic head resection: the dual-center, randomized, controlled PANDRA trial (ISRCTN04937707). Ann Surg. 2016;264:528–37.CrossRefPubMed
10.
go back to reference Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408–10.CrossRefPubMed Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408–10.CrossRefPubMed
11.
go back to reference Gagner M, Pomp A. Laparoscopic pancreatic resection: is it worthwhile? J Gastrointest Surg. 1997;1:20–5 (discussion 25–6).CrossRefPubMed Gagner M, Pomp A. Laparoscopic pancreatic resection: is it worthwhile? J Gastrointest Surg. 1997;1:20–5 (discussion 25–6).CrossRefPubMed
12.
go back to reference Wellner UF, Küsters S, Sick O, Busch C, Bausch D, Bronsert P, et al. Hybrid laparoscopic versus open pylorus-preserving pancreatoduodenectomy: retrospective matched case comparison in 80 patients. Langenbecks Arch Surg. 2014;399:849–56.CrossRefPubMed Wellner UF, Küsters S, Sick O, Busch C, Bausch D, Bronsert P, et al. Hybrid laparoscopic versus open pylorus-preserving pancreatoduodenectomy: retrospective matched case comparison in 80 patients. Langenbecks Arch Surg. 2014;399:849–56.CrossRefPubMed
13.
go back to reference Mendoza AS III, Han H-S, Yoon Y-S, Cho JY, Choi Y. Laparoscopy-assisted pancreaticoduodenectomy as minimally invasive surgery for periampullary tumors: a comparison of short-term clinical outcomes of laparoscopy-assisted pancreaticoduodenectomy and open pancreaticoduodenectomy. J Hepato-Biliary-Pancreat Sci. 2015;22:819–24.CrossRef Mendoza AS III, Han H-S, Yoon Y-S, Cho JY, Choi Y. Laparoscopy-assisted pancreaticoduodenectomy as minimally invasive surgery for periampullary tumors: a comparison of short-term clinical outcomes of laparoscopy-assisted pancreaticoduodenectomy and open pancreaticoduodenectomy. J Hepato-Biliary-Pancreat Sci. 2015;22:819–24.CrossRef
14.
go back to reference Wang Y, Bergman S, Piedimonte S, Vanounou T. Bridging the gap between open and minimally invasive pancreaticoduodenectomy: the hybrid approach. Can J Surg. 2014;57:263–70.CrossRefPubMedPubMedCentral Wang Y, Bergman S, Piedimonte S, Vanounou T. Bridging the gap between open and minimally invasive pancreaticoduodenectomy: the hybrid approach. Can J Surg. 2014;57:263–70.CrossRefPubMedPubMedCentral
15.
go back to reference Pędziwiatr M, Małczak P, Pisarska M, Major P, Wysocki M, Stefura T, et al. Minimally invasive versus open pancreatoduodenectomy-systematic review and meta-analysis. Langenbecks Arch Surg. 2017;8:408–11. Pędziwiatr M, Małczak P, Pisarska M, Major P, Wysocki M, Stefura T, et al. Minimally invasive versus open pancreatoduodenectomy-systematic review and meta-analysis. Langenbecks Arch Surg. 2017;8:408–11.
16.
go back to reference Palanivelu C, Jani K, Senthilnathan P, Parthasarathi R, Rajapandian S, Madhankumar MV. Laparoscopic pancreaticoduodenectomy: technique and outcomes. ACS. 2007;205:222–30. Palanivelu C, Jani K, Senthilnathan P, Parthasarathi R, Rajapandian S, Madhankumar MV. Laparoscopic pancreaticoduodenectomy: technique and outcomes. ACS. 2007;205:222–30.
17.
go back to reference Croome KP, Farnell MB, Que FG, Reid-Lombardo K, Truty MJ, Nagorney DM, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg. 2014;260:633–40.CrossRefPubMed Croome KP, Farnell MB, Que FG, Reid-Lombardo K, Truty MJ, Nagorney DM, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg. 2014;260:633–40.CrossRefPubMed
18.
go back to reference Stauffer JA, Coppola A, Villacreses D, Mody K, Johnson E, Li Z, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc. 2017. doi:10.1007/s00464-016-5222-1.PubMed Stauffer JA, Coppola A, Villacreses D, Mody K, Johnson E, Li Z, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc. 2017. doi:10.​1007/​s00464-016-5222-1.PubMed
19.
go back to reference Pessaux P, Varma D, Arnaud J. Pancreaticoduodenectomy: superior mesenteric artery first approach. J Gastrointest Surg. 2006;10:607–11.CrossRefPubMed Pessaux P, Varma D, Arnaud J. Pancreaticoduodenectomy: superior mesenteric artery first approach. J Gastrointest Surg. 2006;10:607–11.CrossRefPubMed
20.
go back to reference Weitz J, Rahbari N, Koch M, Büchler MW. The “artery first” approach for resection of pancreatic head cancer. J Am Coll Surg. 2010;210:e1–4.CrossRefPubMed Weitz J, Rahbari N, Koch M, Büchler MW. The “artery first” approach for resection of pancreatic head cancer. J Am Coll Surg. 2010;210:e1–4.CrossRefPubMed
21.
go back to reference Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA. “Artery-first” approaches to pancreatoduodenectomy. Br J Surg. 2012;99:1027–35.CrossRefPubMed Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA. “Artery-first” approaches to pancreatoduodenectomy. Br J Surg. 2012;99:1027–35.CrossRefPubMed
22.
go back to reference Pittau G, Sànchez-Cabùs S, Laurenzi A, Gelli M, Cunha AS. Laparoscopic pancreaticoduodenectomy: right posterior superior mesenteric artery “first” approach. Ann Surg Oncol. 2015;22(Suppl 3):S345–8.CrossRefPubMed Pittau G, Sànchez-Cabùs S, Laurenzi A, Gelli M, Cunha AS. Laparoscopic pancreaticoduodenectomy: right posterior superior mesenteric artery “first” approach. Ann Surg Oncol. 2015;22(Suppl 3):S345–8.CrossRefPubMed
23.
go back to reference Nagakawa Y, Hosokawa Y, Sahara Y, Takishita C, Nakajima T, Hijikata Y, et al. A novel, “artery first” approach allowing safe resection in laparoscopic pancreaticoduodenectomy: the uncinate process first approach. Hepatogastroenterology. 2015;62:1037–40.PubMed Nagakawa Y, Hosokawa Y, Sahara Y, Takishita C, Nakajima T, Hijikata Y, et al. A novel, “artery first” approach allowing safe resection in laparoscopic pancreaticoduodenectomy: the uncinate process first approach. Hepatogastroenterology. 2015;62:1037–40.PubMed
24.
go back to reference Müller SA, Hartel M, Mehrabi A, Welsch T, Martin DJ, Hinz U, et al. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg. 2009;13:784–92.CrossRefPubMed Müller SA, Hartel M, Mehrabi A, Welsch T, Martin DJ, Hinz U, et al. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg. 2009;13:784–92.CrossRefPubMed
25.
go back to reference Kaneoka Y, Yamaguchi A, Isogai M. Portal or superior mesenteric vein resection for pancreatic head adenocarcinoma: prognostic value of the length of venous resection. Surgery. 2009;145:417–25.CrossRefPubMed Kaneoka Y, Yamaguchi A, Isogai M. Portal or superior mesenteric vein resection for pancreatic head adenocarcinoma: prognostic value of the length of venous resection. Surgery. 2009;145:417–25.CrossRefPubMed
26.
go back to reference Martin RCG, Scoggins CR, Egnatashvili V, Staley CA, McMasters KM, Kooby DA. Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes. Arch Surg. 2009;144:154–9.CrossRefPubMed Martin RCG, Scoggins CR, Egnatashvili V, Staley CA, McMasters KM, Kooby DA. Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes. Arch Surg. 2009;144:154–9.CrossRefPubMed
27.
go back to reference D’Angelo F, Antolino L, Farcomeni A, Sirimarco D, Kazemi Nava A, De Siena M, et al. Neoadjuvant treatment in pancreatic cancer: evidence-based medicine? A systematic review and meta-analysis. Med Oncol. 2017;34:85.CrossRefPubMed D’Angelo F, Antolino L, Farcomeni A, Sirimarco D, Kazemi Nava A, De Siena M, et al. Neoadjuvant treatment in pancreatic cancer: evidence-based medicine? A systematic review and meta-analysis. Med Oncol. 2017;34:85.CrossRefPubMed
28.
go back to reference Kendrick ML, Sclabas GM. Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford). 2011;13:454–8.CrossRef Kendrick ML, Sclabas GM. Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford). 2011;13:454–8.CrossRef
29.
go back to reference Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, et al. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg. 2015;19:189–94 (discussion 194).CrossRefPubMed Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, et al. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg. 2015;19:189–94 (discussion 194).CrossRefPubMed
30.
go back to reference Giulianotti PC, Addeo P, Buchs NC, Ayloo SM, Bianco FM. Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors. Pancreas. 2011;40:1264–70.CrossRefPubMed Giulianotti PC, Addeo P, Buchs NC, Ayloo SM, Bianco FM. Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors. Pancreas. 2011;40:1264–70.CrossRefPubMed
31.
go back to reference Speicher PJ, Nussbaum DP, White RR, Zani S, Mosca PJ, Blazer DG, et al. Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy. Ann Surg Oncol. 2014;21:4014–9.CrossRefPubMed Speicher PJ, Nussbaum DP, White RR, Zani S, Mosca PJ, Blazer DG, et al. Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy. Ann Surg Oncol. 2014;21:4014–9.CrossRefPubMed
32.
go back to reference Liao C-H, Liu Y-Y, Wang S-Y, Liu K-H, Yeh C-N, Yeh T-S. The feasibility of laparoscopic pancreaticoduodenectomy—a stepwise procedure and learning curve. Langenbecks Arch Surg. 2016. doi:10.1007/s00423-016-1541-x.PubMed Liao C-H, Liu Y-Y, Wang S-Y, Liu K-H, Yeh C-N, Yeh T-S. The feasibility of laparoscopic pancreaticoduodenectomy—a stepwise procedure and learning curve. Langenbecks Arch Surg. 2016. doi:10.​1007/​s00423-016-1541-x.PubMed
34.
35.
go back to reference Adam MA, Thomas S, Youngwirth L, Pappas T, Roman SA, Sosa JA. Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States. JAMA Surg. 2017;152:336–42.CrossRefPubMed Adam MA, Thomas S, Youngwirth L, Pappas T, Roman SA, Sosa JA. Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States. JAMA Surg. 2017;152:336–42.CrossRefPubMed
36.
go back to reference Cuschieri A. Laparoscopic surgery of the pancreas. J R Coll Surg Edinb. 1994;39:178–84.PubMed Cuschieri A. Laparoscopic surgery of the pancreas. J R Coll Surg Edinb. 1994;39:178–84.PubMed
37.
go back to reference Edwin B, Sahakyan MA, Hilal MA, Besselink MG, Braga M, Fabre J-M, et al. Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference. Surg Endosc. 2017;31:2023–41.CrossRefPubMed Edwin B, Sahakyan MA, Hilal MA, Besselink MG, Braga M, Fabre J-M, et al. Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference. Surg Endosc. 2017;31:2023–41.CrossRefPubMed
38.
go back to reference de Rooij T, Besselink MG, Shamali A, Butturini G, Busch OR, Edwin B, et al. Pan-European survey on the implementation of minimally invasive pancreatic surgery with emphasis on cancer. HPB. 2016;18:170–6.CrossRefPubMed de Rooij T, Besselink MG, Shamali A, Butturini G, Busch OR, Edwin B, et al. Pan-European survey on the implementation of minimally invasive pancreatic surgery with emphasis on cancer. HPB. 2016;18:170–6.CrossRefPubMed
39.
go back to reference Ricci C, Casadei R, Taffurelli G, Pacilio CA, Minni F. Laparoscopic distal pancreatectomy: many meta-analyses, few certainties. Updates Surg. 2016;68:225–34.CrossRefPubMed Ricci C, Casadei R, Taffurelli G, Pacilio CA, Minni F. Laparoscopic distal pancreatectomy: many meta-analyses, few certainties. Updates Surg. 2016;68:225–34.CrossRefPubMed
40.
go back to reference Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MG, Davidson BR, et al. Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Gurusamy KS, editor. Chichester, UK: Wiley; 2016. Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MG, Davidson BR, et al. Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Gurusamy KS, editor. Chichester, UK: Wiley; 2016.
41.
go back to reference Røsok BI, de Rooij T, van Hilst J, Diener MK, Allen PJ, Vollmer CM, et al. Minimally invasive distal pancreatectomy. HPB (Oxford). 2017;19:205–14.CrossRef Røsok BI, de Rooij T, van Hilst J, Diener MK, Allen PJ, Vollmer CM, et al. Minimally invasive distal pancreatectomy. HPB (Oxford). 2017;19:205–14.CrossRef
42.
go back to reference Nigri G, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, et al. Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery. 2013;153:111–9.CrossRefPubMed Nigri G, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, et al. Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery. 2013;153:111–9.CrossRefPubMed
43.
go back to reference Probst P, Hüttner FJ, Klaiber U, Knebel P. Stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy. Cochrane Database Syst Rev. 2015;6:CD008688. Probst P, Hüttner FJ, Klaiber U, Knebel P. Stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy. Cochrane Database Syst Rev. 2015;6:CD008688.
44.
go back to reference Choi SH, Kang CM, Kim JY, Hwang HK, Lee WJ. Laparoscopic extended (subtotal) distal pancreatectomy with resection of both splenic artery and vein. Surg Endosc. 2013;27:1412–3.CrossRefPubMed Choi SH, Kang CM, Kim JY, Hwang HK, Lee WJ. Laparoscopic extended (subtotal) distal pancreatectomy with resection of both splenic artery and vein. Surg Endosc. 2013;27:1412–3.CrossRefPubMed
45.
go back to reference Fernández-Cruz L, Cosa R, Blanco L, Levi S, López-Boado M-A, Navarro S. Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg. 2007;11:1607–22.CrossRefPubMed Fernández-Cruz L, Cosa R, Blanco L, Levi S, López-Boado M-A, Navarro S. Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg. 2007;11:1607–22.CrossRefPubMed
46.
go back to reference Mekeel KL, Moss AA, Reddy KS, Mulligan DC, Harold KL. Laparoscopic distal pancreatectomy: does splenic preservation affect outcomes? Surg Laparosc Endosc Percutan Tech. 2011;21:362–5.CrossRefPubMed Mekeel KL, Moss AA, Reddy KS, Mulligan DC, Harold KL. Laparoscopic distal pancreatectomy: does splenic preservation affect outcomes? Surg Laparosc Endosc Percutan Tech. 2011;21:362–5.CrossRefPubMed
47.
go back to reference Ricci C, Casadei R, Taffurelli G, Bogoni S, D’Ambra M, Ingaldi C, et al. Laparoscopic distal pancreatectomy in benign or premalignant pancreatic lesions: is it really more cost-effective than open approach? J Gastrointest Surg. 2015;19:1415–24.CrossRefPubMed Ricci C, Casadei R, Taffurelli G, Bogoni S, D’Ambra M, Ingaldi C, et al. Laparoscopic distal pancreatectomy in benign or premalignant pancreatic lesions: is it really more cost-effective than open approach? J Gastrointest Surg. 2015;19:1415–24.CrossRefPubMed
48.
go back to reference Braga M, Pecorelli N, Ferrari D, Balzano G, Zuliani W, Castoldi R. Results of 100 consecutive laparoscopic distal pancreatectomies: postoperative outcome, cost-benefit analysis, and quality of life assessment. Surg Endosc. 2015;29:1871–8.CrossRefPubMed Braga M, Pecorelli N, Ferrari D, Balzano G, Zuliani W, Castoldi R. Results of 100 consecutive laparoscopic distal pancreatectomies: postoperative outcome, cost-benefit analysis, and quality of life assessment. Surg Endosc. 2015;29:1871–8.CrossRefPubMed
49.
go back to reference Coolsen MME, van Dam RM, van der Wilt AA, Slim K, Lassen K, Dejong CHC. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg. 2013;37:1909–18.CrossRefPubMed Coolsen MME, van Dam RM, van der Wilt AA, Slim K, Lassen K, Dejong CHC. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg. 2013;37:1909–18.CrossRefPubMed
50.
go back to reference Kagedan DJ, Ahmed M, Devitt KS, Wei AC. Enhanced recovery after pancreatic surgery: a systematic review of the evidence. HPB (Oxford). 2015;17:11–6.CrossRef Kagedan DJ, Ahmed M, Devitt KS, Wei AC. Enhanced recovery after pancreatic surgery: a systematic review of the evidence. HPB (Oxford). 2015;17:11–6.CrossRef
51.
go back to reference Pędziwiatr M, Pisarska M, Kisielewski M, Matłok M, Major P, Wierdak M, et al. Is ERAS in laparoscopic surgery for colorectal cancer changing risk factors for delayed recovery? Med Oncol. 2016;33:10–25.CrossRef Pędziwiatr M, Pisarska M, Kisielewski M, Matłok M, Major P, Wierdak M, et al. Is ERAS in laparoscopic surgery for colorectal cancer changing risk factors for delayed recovery? Med Oncol. 2016;33:10–25.CrossRef
52.
go back to reference Pędziwiatr M, Pisarska M, Major P, Grochowska A, Matłok M, Przęczek K, et al. Laparoscopic colorectal cancer surgery combined with enhanced recovery after surgery protocol (ERAS) reduces the negative impact of sarcopenia on short-term outcomes. Eur J Surg Oncol. 2016;42:779–87.CrossRefPubMed Pędziwiatr M, Pisarska M, Major P, Grochowska A, Matłok M, Przęczek K, et al. Laparoscopic colorectal cancer surgery combined with enhanced recovery after surgery protocol (ERAS) reduces the negative impact of sarcopenia on short-term outcomes. Eur J Surg Oncol. 2016;42:779–87.CrossRefPubMed
Metadata
Title
Minimally invasive pancreatic cancer surgery: What is the current evidence?
Authors
Michał Pędziwiatr
Piotr Małczak
Piotr Major
Jan Witowski
Beata Kuśnierz-Cabala
Piotr Ceranowicz
Andrzej Budzyński
Publication date
01-07-2017
Publisher
Springer US
Published in
Medical Oncology / Issue 7/2017
Print ISSN: 1357-0560
Electronic ISSN: 1559-131X
DOI
https://doi.org/10.1007/s12032-017-0984-4

Other articles of this Issue 7/2017

Medical Oncology 7/2017 Go to the issue