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World J Gastroenterol. Oct 21, 2014; 20(39): 14255-14262
Published online Oct 21, 2014. doi: 10.3748/wjg.v20.i39.14255
Laparoscopic resection of pancreatic adenocarcinoma: Dream or reality?
Blaire Anderson, Shahzeer Karmali
Blaire Anderson, Shahzeer Karmali, Department of Surgery, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
Shahzeer Karmali, Center for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alberta T5H 3V9, Canada
Author contributions: Anderson B reviewed the literature and wrote the paper; Karmali S supervised the review.
Correspondence to: Shahzeer Karmali, BSc, MD, MPH, Assistant Professor, Surgical Director, Weight Wise Bariatric Surgery, Minimally Invasive Gastrointestinal and Bariatric Surgery, Center for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Room 405 Community Services Center, 10240 Kingsway, Edmonton, Alberta T5H 3V9, Canada. shahzeer@ualberta.ca
Telephone: +1-780-7356650 Fax: +1-780-7356652
Received: November 28, 2013
Revised: January 27, 2014
Accepted: May 29, 2014
Published online: October 21, 2014
Processing time: 326 Days and 17.2 Hours
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.

Keywords: Laparoscopic surgery; Pancreatic cancer; Laparoscopic distal pancreatectomy; Laparoscopic pancreaticoduodenectomy; Adenocarcinoma

Core tip: Laparoscopic pancreatic surgery is in its infancy despite initial procedures reported two decades ago. Both laparoscopic distal pancreatectomy and laparoscopic pancreaticoduodenectomy can be performed competently with improved perioperative outcomes, similar to those observed when minimally invasive surgical (MIS) is utilized for other purposes. However, when MIS approaches are implemented the indication is often benign or low-grade malignant pathologies. In this review we explore the evidence available regarding laparoscopic resection of pancreatic adenocarcinoma, a promising approach for future widespread application.