Laparoscopic distal pancreatectomy employing radical en bloc procedure for adenocarcinoma: Technical details and outcomes

Kawaguchi, Yoshikuni; Fuks, David; Nomi, Takeo; Levard, H; Gayet, Brice

doi:10.1016/j.surg.2014.12.015

Cited by 22 publications

(14 citation statements)

References 37 publications

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“…The search strategy yielded 411 articles and we checked the title and abstract of the studies according to the inclusion and exclusion criteria and selected 53 articles. After the full texts of the remaining articles were read, 15 articles were included in the meta-analysis of MI-SPDP versus MI-DPS [13,[17][18][19][20][21][22][23][24][25][26][27][28][29][30] and 15 articles were included in the meta-analysis of MI-SVP versus MI-WT [13,23,[31][32][33][34][35][36][37][38][39][40][41][42][43]. Figure 1 shows the flow diagram of study identification and evaluation during the review process.…”

Section: Resultsmentioning

confidence: 99%

Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta‐analysis

Nakata

Shikata

Ohtsuka

et al. 2018

J Hepato Biliary Pancreat

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Section: Resultsmentioning

confidence: 99%

Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta‐analysis

Nakata

Shikata

Ohtsuka

et al. 2018

J Hepato Biliary Pancreat

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“…Of the studies that report specifically on LDP for pancreatic cancer, Lee et al [18] did so in a highly selected group of patients (tumours confined to the pancreas), and whilst reporting excellent results their outcomes are not applicable to the treatment of all patients with left-sided cancers. Kawaguchi et al [19] also showed promising results though their technique departs widely from established oncosurgical practice since they preserved the spleen in 17 of 24 patients [11]. …”

Section: Discussionmentioning

confidence: 99%

“…Two studies report on the subject of the feasibility of the laparoscopic approach oncologically and showed promising results with 13 case series [13] showing an R1 resection rate of 23 % and a non-inferiority study [14] showing equivalence versus the open approach. Five further selected series [15–19] report on laparoscopic distal pancreatectomy for a mixture of benign and malignant conditions using multiple described techniques including radical en bloc resection in one series preserving the spleen. Between them a total of 56 patients underwent LDP for pancreatic ductal adenocarcinoma.…”

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confidence: 99%

Laparoscopic radical ‘no-touch’ left pancreatosplenectomy for pancreatic ductal adenocarcinoma: technique and results

et al. 2015

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BackgroundLaparoscopic left pancreatectomy has been well described for benign pancreatic lesions, but its role in pancreatic adenocarcinoma remains open to debate. We report our results adopting a laparoscopic technique that obeys established oncologic principles of open distal pancreatosplenectomy.MethodsThis is a post hoc analysis of a prospectively kept database of 135 consecutive patients undergoing laparoscopic left pancreatectomy, performed across two sites in the UK and the Netherlands (07/2007–07/2015 Southampton and 10/2013–07/2015 Amsterdam). Primary outcomes were resection margin and lymph node retrieval. Secondary endpoints were other perioperative outcomes, including post-operative pancreatic fistula. Definition of radical resection was distance tumour to resection margin >1 mm. All patients underwent ‘laparoscopic radical left pancreatosplenectomy’ (LRLP) which involves ‘hanging’ the pancreas including Gerota’s fascia, followed by clockwise dissection, including formal lymphadenectomy.ResultsLRLP for pancreatic adenocarcinoma was performed in 25 patients. Seven of the 25 patients (28 %) had extended resections, including the adrenal gland (n = 3), duodenojejunal flexure (n = 2) or transverse mesocolon (n = 3). Mean age was 68 years (54–81). Conversion rate was 0 %, mean operative time 240 min and mean blood loss 340 ml. Median intensive/high care and hospital stay were 1 and 5 days, respectively. Clavien–Dindo score 3+ complication rate was 12 % and ISGPF grade B/C pancreatic fistula rate 28 %; 90-day (or in-hospital) mortality was 0 %. The pancreatic resection margin was clear in all patients, and the posterior margin was involved (<1 mm) in 6 patients, meaning an overall R0 resection rate of 76 %. No resection margin was microscopically involved. Median nodal sample was 15 nodes (3–26). With an average follow-up of 17.2 months, 1-year survival was 88 %.ConclusionsA standardised laparoscopic approach to pancreatic adenocarcinoma in the left pancreas can be adopted safely. Our study shows that these results can be reproduced across multiple sites using the same technique.

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“…LDP outcomes are also intended as independent from the pathologies of the patients before surgery, as the intra-operative and post-operative parameters do not differ significantly [26]. Yoshikuni Kawaguchi and his group's data [23] demonstrate a difference regarding the operative time and the difficulty of LDP, according to the choice to resect or preserve the spleen, while the incidences of complications is not affected.…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic pancreatectomy: Did the indications change? A review from literature

Sperlongano

Esposito

et al. 2015

International Journal of Surgery

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Pancreatic Cancer (PC) is the fourth cause of death for tumors in Western countries. Symptoms are not specific, and can vary according to the tumor size and place. Diagnostic workup includes CA 19-9, CT and MRI. Surgery is the only treatment for PC, associated to radio-chemo therapy. Laparoscopic approaches are actually used for PC treatment in few specialized centers, and could be an alternative to laparotomic surgery. The aim of our study is to evaluate the efficacy of laparoscopy for PC treatment compared to laparotomy. We reviewed 19 articles in literature to assess the feasibility and efficacy of Laparoscopic Distal Pancreatectomy (LDP) and Laparoscopic Pancreaticoduodenectomy (LPD). The results have shown that LDP is nowadays a safe technique, and the outcomes are comparable to laparotomic surgery. Regarding to LPD instead, results are controversial and the data are still not sufficient to consider this technique as a valid alternative to laparotomic surgery.

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Laparoscopic distal pancreatectomy employing radical en bloc procedure for adenocarcinoma: Technical details and outcomes

Cited by 22 publications

References 37 publications

Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta‐analysis

Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta‐analysis

Laparoscopic radical ‘no-touch’ left pancreatosplenectomy for pancreatic ductal adenocarcinoma: technique and results

Laparoscopic pancreatectomy: Did the indications change? A review from literature

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