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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2016; 22(32): 7301-7310
Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7301
Pancreatic cancer: Open or minimally invasive surgery?
Yu-Hua Zhang, Cheng-Wu Zhang, Zhi-Ming Hu, De-Fei Hong
Yu-Hua Zhang, Cheng-Wu Zhang, Zhi-Ming Hu, De-Fei Hong, Division of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
Author contributions: Zhang YH and Hong DF designed the study; Zhang YH, Zhang CW, Hu ZM and Hong DF reviewed and analyzed the literature, and drafted and revised the manuscript; All authors approved the final version of the manuscript to be published.
Supported by the Natural Science Foundation of Zhejiang Province, China, No. LY15H160054; and the Key Project of the Science and Technology Department of Zhejiang Province, No. 2013C03046.
Conflict-of-interest statement: The authors declare that there is no potential conflict of interest related to this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: De-Fei Hong, Professor, Division of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China. hongdefi@163.com
Telephone: +86-571-85893396
Received: March 25, 2016
Peer-review started: March 26, 2016
First decision: April 14, 2016
Revised: May 4, 2016
Accepted: May 23, 2016
Article in press: May 23, 2016
Published online: August 28, 2016
Abstract

Pancreatic duct adenocarcinoma is one of the most fatal malignancies, with R0 resection remaining the most important part of treatment of this malignancy. However, pancreatectomy is believed to be one of the most challenging procedures and R0 resection remains the only chance for patients with pancreatic cancer to have a good prognosis. Some surgeons have tried minimally invasive pancreatic surgery, but the short- and long-term outcomes of pancreatic malignancy remain controversial between open and minimally invasive procedures. We collected comparative data about minimally invasive and open pancreatic surgery. The available evidence suggests that minimally invasive pancreaticoduodenectomy (MIPD) is as safe and feasible as open PD (OPD), and shows some benefit, such as less intraoperative blood loss and shorter postoperative hospital stay. Despite the limited evidence for MIPD in pancreatic cancer, most of the available data show that the short-term oncological adequacy is similar between MIPD and OPD. Some surgical techniques, including superior mesenteric artery-first approach and laparoscopic pancreatoduodenectomy with major vein resection, are believed to improve the rate of R0 resection. Laparoscopic distal pancreatectomy is less technically demanding and is accepted in more pancreatic centers. It is technically safe and feasible and has similar short-term oncological prognosis compared with open distal pancreatectomy.

Keywords: Laparoscopic, Minimally invasive, Robotic, Pancreaticoduodenectomy, Distal pancreatectomy, Pancreatic cancer

Core tip: Minimally invasive pancreaticoduodenectomy is as safe and feasible as open pancreaticoduodenectomy (OPD) and shows some superiority. The short-term oncological results are similar between laparoscopic pancreaticoduodenectomy (LPD) and OPD. However, in some experienced hands, better prognosis is detected in the LPD group because the patients can receive adjuvant therapy faster because of the benefits of minimal invasiveness. Minimally invasive distal pancreatectomy is a well-established procedure and widely accepted. It is safe, feasible, and has similar short-term oncological results compared with open distal pancreatectomy.