Published online Mar 7, 2014. doi: 10.3748/wjg.v20.i9.2343
Revised: December 31, 2013
Accepted: January 8, 2014
Published online: March 7, 2014
Minimally invasive distal pancreatectomy with splenectomy has been regarded as a safe and effective treatment for benign and borderline malignant pancreatic lesions. However, its application for left-sided pancreatic cancer is still being debated. The clinical evidence for radical antegrade modular pancreatosplenectomy (RAMPS)-based minimally invasive approaches for left-sided pancreatic cancer was reviewed. Potential indications and surgical concepts for minimally invasive RAMPS were suggested. Despite the limited clinical evidence for minimally invasive distal pancreatectomy in left-sided pancreatic cancer, the currently available clinical evidence supports the use of laparoscopic distal pancreatectomy under oncologic principles in well-selected left sided pancreatic cancers. A pancreas-confined tumor with an intact fascia layer between the pancreas and left adrenal gland/kidney positioned more than 1 or 2 cm away from the celiac axis is thought to constitute a good condition for the use of margin-negative minimally invasive RAMPS. The use of minimally invasive (laparoscopic or robotic) anterior RAMPS is feasible and safe for margin-negative resection in well-selected left-sided pancreatic cancer. The oncologic feasibility of the procedure remains to be determined; however, the currently available interim results indicate that even oncologic outcomes will not be inferior to those of open radical distal pancreatosplenectomy.
Core tip: Minimally invasive (laparoscopic or robotic) radical distal pancreatosplenectomy is technically feasible and safe for margin-negative resection in well-selected left sided pancreatic cancer. Generally acceptable potential indications are proposed to include the following: (1) pancreas-confined tumors; (2) intact fascia layer between the distal pancreas and left adrenal gland/kidney; and (3) tumor 1-2 cm from celiac axis. The long-term oncologic feasibility remains to be discerned, but the currently available interim results are encouraging. Further clinical experience with this minimally invasive approach for left-sided pancreatic cancer should be accumulated by experienced surgeons. In the near future, surgical approaches should be specified according to the conditions of the individual pancreatic cancer case.