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. 2017 May;31(5):2023-2041.
doi: 10.1007/s00464-017-5414-3. Epub 2017 Feb 15.

Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference

Bjørn Edwin  1   2   3 , Mushegh A Sahakyan  4   5 , Mohammad Abu Hilal  6 , Marc G Besselink  7 , Marco Braga  8 , Jean-Michel Fabre  9 , Laureano Fernández-Cruz  10 , Brice Gayet  11   12 , Song Cheol Kim  13 , Igor E Khatkov  14   15 ; EAES Consensus Conference Study Group
Collaborators, Affiliations

Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference

Bjørn Edwin et al. Surg Endosc. 2017 May.

Abstract

Background: Introduced more than 20 years ago, laparoscopic pancreatic surgery (LAPS) has not reached a uniform acceptance among HPB surgeons. As a result, there is no consensus regarding its use in patients with pancreatic neoplasms. This study, organized by the European Association for Endoscopic Surgery (EAES), aimed to develop consensus statements and clinical recommendations on the application of LAPS in these patients.

Methods: An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreatic surgery. Each panelist performed a critical appraisal of the literature and prepared evidence-based statements assessed by other panelists during Delphi process. The statements were further discussed during a one-day face-to-face meeting followed by the second round of Delphi. Modified statements were presented at the plenary session of the 24th International Congress of the EAES in Amsterdam and in a web-based survey.

Results: LAPS included laparoscopic distal pancreatectomy (LDP), pancreatoduodenectomy (LPD), enucleation, central pancreatectomy, and ultrasound. In general, LAPS was found to be safe, especially in experienced hands, and also advantageous over an open approach in terms of intraoperative blood loss, postoperative recovery, and quality of life. Eighty-five percent or higher proportion of responders agreed with the majority (69.5%) of statements. However, the evidence is predominantly based on retrospective case-control studies and systematic reviews of these studies, clearly affected by selection bias. Furthermore, no randomized controlled trials (RCTs) have been published to date, although four RCTs are currently underway in Europe.

Conclusions: LAPS is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. LDP is feasible and safe, performed in many centers, while LPD is limited to few centers. RCTs and registry studies are essential to proceed with the assessment of LAPS.

Keywords: Consensus; Enucleation; Laparoscopy; Pancreatectomy; Pancreatoduodenectomy.

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