Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution

Abstract

Laparoscopic left pancreatectomy for benign and malignant lesions is feasible, safe, and beneficial. We believe that pancreatoduodenectomy should be performed only in selected cases and by a highly skilled laparoscopic surgeon. If there is any doubt, an open resection should be performed.

Laparoscopic pancreatectomy: Indications and outcomes

“…TLPD and the hybrid approach have similar mean operative time (268 min vs 286 min), blood loss (75 cc vs 83 cc), complication rate (33% vs 25%), and length of stay (13.4 d vs 14 d) [45] . Several retrospective series demonstrate that MIPD can be safely performed in experienced hands.…”

“…Despite the known benefits of laparoscopy, the anatomic challenges, the inherent technical complexity of this operation and the difficulty of performing three major anastomoses have limited the widespread use of minimally invasive cal and reconstructive challenges previously mentioned. There are two general approaches to MIPD: a total laparoscopic approach (TLPD) where the anastomoses (pancreaticojejunostomy, hepaticojejunostomy, gastrojejunostomy) along with the resection are done intracorporeally; and the laparoscopic-assisted, or hybrid approach where the reconstruction is done through a small incision which is also used for specimen extraction [38,40,42,[44][45][46] .…”

“…Most MIPD series report low mortality rate [38][39][40][41][42][43][44][45][46] ; Gumbs et al [48] reviewed 285 cases and found the overall mortality was 2%. A more recent series reports a 100-d mortality rate of 5.7%, which is not significantly different than the mortality rate of 8.8% in the OPD group in the same series [35] .…”

“…Cho et al [38] and Asbun and Stauffer [35] compared their MIPD to contemporary OPD, and found that the OPD group have similar rate of pancreatic fistula (3%-13%). Other complications reported include biliary leak (2.4%-7%) [38,40,41] , delayed gastric emptying (7%-9.1%) [38,44] , small bowel obstruction 6.2% [45] , intra-abdominal hemorrhage (5.3%) [40] , intra-abdominal abscess (2.4%-19.9%) [35,40] , wound infection (11.3%) [35] , pulmonary complications and DVT (2.4%-14.3%) [39,41] . The average length of stay for MIPD varies between 8 and 18 [35,[38][39][40][41]44,45] .…”

“…Other complications reported include biliary leak (2.4%-7%) [38,40,41] , delayed gastric emptying (7%-9.1%) [38,44] , small bowel obstruction 6.2% [45] , intra-abdominal hemorrhage (5.3%) [40] , intra-abdominal abscess (2.4%-19.9%) [35,40] , wound infection (11.3%) [35] , pulmonary complications and DVT (2.4%-14.3%) [39,41] . The average length of stay for MIPD varies between 8 and 18 [35,[38][39][40][41]44,45] . Asbun et al [35] found that the length of stay is significantly shorter in MIPD group compared to OPD group (8 d vs 12.4 d), whereas Cho et al [38] did not (16.4 d vs 15.6 d) [38] .…”