Published online Dec 16, 2018. doi: 10.4253/wjge.v10.i12.383
Peer-review started: August 28, 2018
First decision: October 4, 2018
Revised: November 5, 2018
Accepted: December 5, 2018
Article in press: December 5, 2018
Published online: December 16, 2018
The laparoscopic technique in distal pancreatic resection (LDP) has been widely accepted, and outcome data support the hypothesis that survival is improved, partly due to improved postoperative safety and recovery, thus optimizing treatment with adjuvant chemotherapy. But laparoscopic pancreaticoduodenectomy (LPD or Whipple-procedures) has spread more slowly, due to the complexity of the procedure. Surgical safety has been a problem in hospitals with low patient volume, resulting in raised postoperative mortality, requiring careful monitoring of outcome during the surgical learning curve. Robotic assistance is expected to improve surgical safety, but data on long term oncological outcome of laparoscopic Whipple procedures with or without robotic assistance is scarce. Future research should still focus surgical safety, but most importantly long term outcome, recorded as recurrence at maximal follow up or - at best - overall long term survival (OS). Available data show median survival above 2.5 years, five year OS more than 30% after LDP even in series with suboptimal adjuvant chemotherapy. Also after LPD, long term survival is reported equal to or longer than open resection. However, surgical safety during the learning curve of LPD is a problem, which hopefully can be facilitated by robotic assistance. Patient reported outcome should also be an endpoint in future trials, including patients with pancreatic ductal adenocarcinoma.
Core tip: Laparoscopic techniques have profoundly altered oncological gastrointestinal surgery, also resectional treatment of pancreatic ductal adenocarcinoma. Long term outcome of distal resections has been gradually improved. Median survival is more than 2.5 years, five year overall survival above 30%, whereas outcome of laparoscopic pancreaticoduodenectomy needs further evaluation before the technique can be widespread. It is an open question how wide this spread ought to be, but robotic assistance is expected to improve surgical safety.