Laparoscopic minor pancreatic resections (enucleations/atypical resections). A long-term appraisal of a supposed mini-invasive approach.

Abstract

IntroductionA few retrospective, small, often multicentric studies show encouraging results of laparoscopic minor pancreatic surgery, but do not allow for an evaluation of feasibility and effectiveness.AimEvaluation of the results of laparoscopic minor pancreatic resections (LMPR), including atypical resections and enucleations.Material and methodsThe outcome of all consecutive patients undergoing LMPR in a tertiary care university hospital specializing in the laparoscopic approach to solid organs (I.M.M., Paris – France) was retrospectively evaluated by the analysis of operating time, blood loss, conversion, morbidity, stay and late outcome.ResultsThirty-three patients underwent LMPR (29 enucleations and 4 atypical resections) for various diseases. The conversion rate was 21%, mean operating time 189 min, and mean blood loss 133 ml. Morbidity was 60%; 10 patients (30%) presented a pancreatic fistula. Pancreatic fistula was independent of type of resection, technique of pancreas section, management of enucleated surface and somatostatin administration. Median stay for enucleations was 18 days. Mean follow-up was 61 months.ConclusionsLaparoscopic pancreatic enucleation is feasible and safe, with no mortality, no lengthening of operating time and a high success rate. Conversely, it does not imply a reduction in complications or hospital stay at the present state of the art.

Minimally invasive versus open pancreatic enucleation. Systematic review and meta‐analysis of surgical outcomes

“…On the basis of titles and abstracts, a total of 39 potentially pertinent records were detected. Nine additional records were identified by hand searching of bibliographies, for a total of 48 records . After the evaluation of full‐texts, eight studies met all the inclusion criteria and were considered eligible for data extraction and meta‐analysis.…”

“…After the evaluation of full‐texts, eight studies met all the inclusion criteria and were considered eligible for data extraction and meta‐analysis. The remaining studies were excluded for the following reasons: impossibility to extrapolate detailed data of MIS versus open surgery: 14 studies, absence of a comparator group: 18 studies, reviews articles: 7 studies and presence of duplicate data: 1 study . The selection process is described in Figure , while Table depicts the general characteristics of the included studies.…”

“…This is true for both distal pancreatectomy and pancreaticoduodenectomy . On the other hand, as far as pancreatic enucleation is concerned, possible clinical benefits of minimally invasive surgery have still to be clearly defined . Currently, selected patients with small low‐aggressive pancreatic neoplasms can be considered candidates for pancreatic enucleation, with the aim of preserving as much healthy pancreatic parenchyma as possible .…”

“…Indeed, despite possible clinical advantages on endocrine and exocrine function, the risk of POPF is believed to be higher following EN as compared to formal segmental resection . Also due to this, the penetration of the minimally invasive method in clinical practice has proceeded with caution . Particularly, it has been suggested that the application of MIS may result in worse outcomes as compared to conventional surgery, especially in terms of POPF .…”

“…Of note, recent reviews have suggested possible advantages with respect to operation time, length of hospitalization, and major morbidity . Conversely, some reports reveal that enucleation may be performed via minimally invasive procedures with the usual advantages of MIS, but at the cost of higher risk of postoperative pancreatic fistula (POPF) compared to conventional surgery . Therefore, the potential advantages of MIS over conventional celiotomy to enucleate pancreatic tumors are still to be clearly defined …”