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Review
. 2016 Aug 28;22(32):7301-10.
doi: 10.3748/wjg.v22.i32.7301.

Pancreatic cancer: Open or minimally invasive surgery?

Yu-Hua Zhang  1 , Cheng-Wu Zhang  1 , Zhi-Ming Hu  1 , De-Fei Hong  1
Affiliations
Review

Pancreatic cancer: Open or minimally invasive surgery?

Yu-Hua Zhang et al. World J Gastroenterol. .

Abstract

Pancreatic duct adenocarcinoma is one of the most fatal malignancies, with R0 resection remaining the most important part of treatment of this malignancy. However, pancreatectomy is believed to be one of the most challenging procedures and R0 resection remains the only chance for patients with pancreatic cancer to have a good prognosis. Some surgeons have tried minimally invasive pancreatic surgery, but the short- and long-term outcomes of pancreatic malignancy remain controversial between open and minimally invasive procedures. We collected comparative data about minimally invasive and open pancreatic surgery. The available evidence suggests that minimally invasive pancreaticoduodenectomy (MIPD) is as safe and feasible as open PD (OPD), and shows some benefit, such as less intraoperative blood loss and shorter postoperative hospital stay. Despite the limited evidence for MIPD in pancreatic cancer, most of the available data show that the short-term oncological adequacy is similar between MIPD and OPD. Some surgical techniques, including superior mesenteric artery-first approach and laparoscopic pancreatoduodenectomy with major vein resection, are believed to improve the rate of R0 resection. Laparoscopic distal pancreatectomy is less technically demanding and is accepted in more pancreatic centers. It is technically safe and feasible and has similar short-term oncological prognosis compared with open distal pancreatectomy.

Keywords: Distal pancreatectomy; Laparoscopic; Minimally invasive; Pancreatic cancer; Pancreaticoduodenectomy; Robotic.

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Figures

Figure 1
Figure 1
Superior mesentery artery was exposed from the right posterior side after complete kocherization. D: Duodenum; IVC: Inferior vena cava; LRV: Left renal vein; PUP: Pancreatic uncinate process; SMA: Superior mesentery artery.
Figure 2
Figure 2
Local vision after removal of the specimen. CT: Celiac trunk; IVC: Inferior vena cava; PV: Portal vein; SMA: Superior mesenteric artery; SMV: Superior mesenteric vein; SPV: Splenic vein.
Figure 3
Figure 3
Vein reconstruction via robotic system. PV: Portal vein; SMV: Superior mesenteric vein.
See this image and copyright information in PMC

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