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World J Gastroenterol. Mar 7, 2014; 20(9): 2343-2351
Published online Mar 7, 2014. doi: 10.3748/wjg.v20.i9.2343
Minimally invasive radical pancreatectomy for left-sided pancreatic cancer: Current status and future perspectives
Chang Moo Kang, Sung Hwan Lee, Woo Jung Lee
Chang Moo Kang, Sung Hwan Lee, Woo Jung Lee, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, South Korea
Chang Moo Kang, Sung Hwan Lee, Woo Jung Lee, Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul 120-752, South Korea
Author contributions: All authors contributed to this work.
Correspondence to: Woo Jung Lee, MD, PhD, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. wjlee@yuhs.ac
Telephone: +82-2-22282120 Fax: +82-2-3138289
Received: October 19, 2013
Revised: December 31, 2013
Accepted: January 8, 2014
Published online: March 7, 2014
Processing time: 138 Days and 1.1 Hours
Abstract

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.

Keywords: Pancreatic cancer; Laparoscopic pancreatectomy, Robotic pancreatectomy

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.