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Journal of Gastrointestinal Cancer
Published in: Journal of Gastrointestinal Cancer 2/2017

01-06-2017 | Review Article

Minimally Invasive Surgical Approaches for Pancreatic Adenocarcinoma: Recent Trends

Authors: Georgios D. Lianos, Dimitrios K. Christodoulou, Konstantinos H. Katsanos, Christos Katsios, Georgios K. Glantzounis

Published in: Journal of Gastrointestinal Cancer | Issue 2/2017

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Abstract

Background

Pancreatic resection for cancer represents a real challenge for every surgeon. Recent improvements in laparoscopic experience, minimally invasive surgical techniques and instruments make now the minimally invasive approach a real “triumph.” There is no doubt that minimally invasive surgery has replaced with great success conventional surgery in many fields, including surgical oncology.

Methods and Results

However, its progress in pancreatic resection for adenocarcinoma has been dramatically slow. Recent evidence supports the notion that minimally invasive distal pancreatectomy is safe and feasible and that is becoming the procedure of choice mainly for benign or low-grade malignant lesions in the distal pancreas. On the other side, minimally invasive pancreatoduodenectomy has not yet been widely accepted and there is enormous skepticism when applied for pancreatic head adenocarcinoma. In this review, we summarize the current evidence on the potential applications of minimally invasive surgical approaches for this aggressive, heterogeneous, and enigmatic type of cancer.

Conclusions

Moreover, the potential future applications of these approaches are discussed with the hope to improve the quality of life as well as the survival rates of pancreatic cancer patients.
Literature
1.
Kausch W. Das carcinoma der papilla duodeni und seine radikale entfeinung. Beitr Z Clin Chir. 1912;78:439–86.
2.
Lieberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg. 1995;222:638–45.CrossRefPubMedPubMedCentral
3.
4.
Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10:1199–210.CrossRefPubMed
5.
6.
Butturini G, Stocken DD, Wente MN, Jeekel H, Klinkenbijl JH, Bakkevold KE, Takada T, Amano H, Dervenis C, Bassi C, Büchler MW, Neoptolemos JP. Influence of resection margins and treatment on survival in patients with pancreatic cancer: meta-analysis of randomized controlled trials. Arch Surg. 2008;143:75–83.CrossRefPubMed
7.
Nguyen NT, Hinojosa MW, Smith BR, Chang KJ, Gray J, Hoyt D. Minimally invasive esophagectomy: lessons learned from 104 operations. Ann Surg. 2008;248:1081–91.CrossRefPubMed
8.
Lianos GD, Rausei S, Ruspi L, Galli F, Mangano A, et al. Laparoscopic gastrectomy for gastric cancer: current evidences. Int J Surg. 2014;12(12):1369–73.CrossRefPubMed
9.
Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomized clinical trial. Lancet Oncol. 2009;10:44–52.CrossRefPubMed
10.
11.
12.
Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408–10.CrossRefPubMed
13.
Palanivelu C, Jani K, Senthilnathan P, Parthasarathi R, Rajapandian S, Madhankumar MV. Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg. 2007;205:222–30.CrossRefPubMed
14.
15.
Ammori BJ, Ayiomamitis GD. Laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a UK experience and a systematic review of the literature. Surg Endosc. 2011;25(7):2084–99.CrossRefPubMed
16.
Ammori BJ, Baghdadi S. Minimally invasive pancreatic surgery: the new frontier? Curr Gastroenterol Rep. 2006;8(2):132–42.CrossRefPubMed
17.
Warner EA, Ben-David K, Cendan JC, Behrns KE. Laparoscopic pancreatic surgery: what now and what next? Curr Gastroenterol Rep. 2009;11(2):128–33.CrossRefPubMed
18.
Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the accordion severity grading system. J Am Coll Surg. 2012;215:810–9.CrossRefPubMed
19.
Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, Souda H, Gunji H, Miyazaki A, Ikeda A, Tohma T, Matsumoto I. Comparison of laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease. Am J Surg. 2009;198:445–9.CrossRefPubMed
20.
Kuroki T, Adachi T, Okamoto T, Kanematsu T. A nonrandomized comparative study of laparoscopy-assisted pancreaticoduodenectomy and open pancreaticoduodenectomy. Hepato-Gastroenterology. 2012;59:570–3.PubMed
21.
Asbun HJ, Stauffer JA. Laparoscopic approach to distal and subtotal pancreatectomy: a clockwise technique. Surg Endosc. 2011;25(8):2643–9.CrossRefPubMed
22.
Mesleh MG, Stauffer JA, Asbun HJ. Minimally invasive surgical techniques for pancreatic cancer: ready for prime time? J Hepatobiliary Pancreat Sci. 2013a;20(6):578–82.CrossRefPubMed
23.
24.
Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg. 2010;145:19–23.CrossRefPubMed
25.
Mesleh MG, Stauffer JA, Bowers SP, Asbun HJ. Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison. Surg Endosc. 2013b;27(12):4518–23.CrossRefPubMed
26.
Gumbs AA, Grès P, Madureira FA, Gayet B. Laparoscopic vs. open resection of noninvasive intraductal pancreatic mucinous neoplasms. J Gastrointest Surg. 2008;12:707–12.CrossRefPubMed
27.
Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc. 2006;20:1045–50.CrossRefPubMed
28.
Kang CM, Lee SH, Lee WJ. Minimally invasive radical pancreatectomy for left-sided pancreatic cancer: current status and future perspectives. World J Gastroenterol. 2014;20(9):2343–51.CrossRefPubMedPubMedCentral
29.
30.
Abu Hilal M, Hamdan M, Di Fabio F, Pearce NW, Johnson CD. Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study. Surg Endosc. 2012;26(6):1670–4.CrossRefPubMed
31.
Nakamura M, Nakashima H. Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci. 2013;20(4):421–8.CrossRefPubMed
32.
Daouadi M, Zureikat AH, Zenati MS, Choudry H, et al. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg. 2013;257(1):128–32.CrossRefPubMed
33.
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
34.
Hwang HK, Kang CM, Chung YE, Kim KA, Choi SH, Lee WJ. Robot-assisted spleen-preserving distal pancreatectomy: a single surgeon's experiences and proposal of clinical application. Surg Endosc. 2013;27(3):774–81.CrossRefPubMed
35.
Beane JD, Pitt HA, Nakeeb A, Schmidt CM, et al. Splenic preserving distal pancreatectomy: does vessel preservation matter? J Am Coll Surg. 2011;212(4):651–7.CrossRefPubMed
36.
Ntourakis D, Marzano E, Lopez Penza PA, Bachellier P, Jaeck D, Pessaux P. Robotic distal splenopancreatectomy: bridging the gap between pancreatic and minimal access surgery. J Gastrointest Surg. 2010;14:1326–30.CrossRefPubMed
37.
Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW. Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc. 2008;22:1334–8.CrossRefPubMed
38.
39.
Ferrone CR, Konstantinidis IT, Sahani DV, Wargo JA, Fernandez-del Castillo C, Warshaw AL. Twenty-three years of the Warshaw operation for distal pancreatectomy with preservation of the spleen. Ann Surg. 2011;253:1136–9.CrossRefPubMed
40.
Shimada K, Sakamoto Y, Sano T, Kosuge T. Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail. Surgery. 2006;139:288–95.CrossRefPubMed
41.
Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg. 2012;255:1048–59.CrossRefPubMed
42.
Jayaraman S, Gonen M, Brennan MF, D’Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR, Allen PJ. Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. J Am Coll Surg. 2010;211:503–9.CrossRefPubMed
43.
44.
45.
Waters JA, Canal DF, Wiebke EA, Dumas RP, Beane JD, et al. Robotic distal pancreatectomy: cost effective? Surgery. 2010;148(4):814–23.CrossRefPubMed
46.
Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G. Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003;138:777–84.CrossRefPubMed
47.
Gall TM, Thompson Z, Dinneen EP, Sodergren M, Pai M, Frampton AE, Jiao LR. Surgical techniques for improving outcomes in pancreatic ductal adenocarcinoma. Expert Rev Gastroenterol Hepatol. 2014;8(3):241–6.CrossRefPubMed
48.
Fernandes E, Giulianotti PC. Robotic-assisted pancreatic surgery. J Hepatobiliary Pancreat Sci. 2013;20(6):583–9.CrossRefPubMed
49.
Narula VK, Mikami DJ, Melvin WS. Robotic and laparoscopic pancreaticoduodenectomy: a hybrid approach. Pancreas. 2010;39:160–4.CrossRefPubMed
50.
Lai EC, Yang GP, Tang CN. Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy—a comparative study. Int J Surg. 2012;10:475–9.CrossRefPubMed
51.
Zhang J, Wu WM, You L, Zhao YP. Robotic versus open pancreatectomy: a systematic review and meta-analysis. Ann Surg Oncol. 2013;20:1774–80.CrossRefPubMed
52.
Cirocchi R, Partelli S, Trastulli S, Coratti A, Parisi A, Falconi M. A systematic review on robotic pancreaticoduodenectomy. Surg Oncol. 2013;22:238–46.CrossRefPubMed
53.
Winer J, Can MF, Bartlett DL, Zeh HJ, Zureikat AH. The current state of robotic-assisted pancreatic surgery. Nat Rev Gastroenterol Hepatol. 2012;9(8):468–76.CrossRefPubMed
54.
Speicher PJ, Nussbaum DP, White RR, et al. Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy. Ann Surg Oncol. 2014;21(12):4014–9.CrossRefPubMed
55.
Boone BA, Zenati M, Hogg ME, et al. Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg. 2015;150(5):416–22.CrossRefPubMed
56.
Balzano G, Bissolati M, Boggi U, Bassi C, Zerbi A, Falconi M. A multicenter survey on distal pancreatectomy in Italy: results of minimally invasive technique and variability of perioperative pathways. Updat Surg. 2014;66(4):253–63.CrossRef
57.
Place TL, Nau P, Mezhir JJ. Minimally invasive pancreatectomy for cancer: a critical review of the current literature. J Gastrointest Surg. 2015;19(2):375–86.CrossRefPubMed
Metadata
Title
Minimally Invasive Surgical Approaches for Pancreatic Adenocarcinoma: Recent Trends
Authors
Georgios D. Lianos
Dimitrios K. Christodoulou
Konstantinos H. Katsanos
Christos Katsios
Georgios K. Glantzounis
Publication date
01-06-2017
Publisher
Springer US
Published in
Journal of Gastrointestinal Cancer / Issue 2/2017
Print ISSN: 1941-6628
Electronic ISSN: 1941-6636
DOI
https://doi.org/10.1007/s12029-017-9934-9

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