Long term oncological outcome of laparoscopic techniques in pancreatic cancer

Abstract

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.

Long‐term oncologic outcomes of robotic and open pancreatectomy in a national cohort of pancreatic adenocarcinoma

“…Robotic pancreatic surgery using the da Vinci surgical system emerged as an alternative to laparoscopy in the middle of the last decade, and reports of its use began to proliferate in 2010. National data suggest this platform to be outpacing its laparoscopic counterpart in pancreatic resections due to perceived advantages of the technology and its relative ease of dissemination 2‐22 23,24 …”

Robotic Whipple for pancreatic ductal and ampullary adenocarcinoma: 10 years experience of a US single‐center

“…With regards to short‐ and long‐term outcomes, our study group compares favorably with most open, laparoscopic, and robotic series 2,6,13,22,26‐29 …”

Current statement and safe implementation of minimally invasive surgery in the pancreas

“…To overcome the issue of Gerota's fascia resection and lymph node retrieval during MIDP, the laparoscopic radical antegrade modular pancreatosplenectomy procedure for left side PDAC may be applicable 15 . MIDP has spread internationally, and the oncological outcomes are mainly elucidated by prospective, observational series 13,16–20 . Due to the absence of RCTs, the oncologic efficacy of MIDP for PDAC remains unclear.…”