Minimally invasive surgery for pancreatic cancer

Abstract

Introduction: Minimally invasive surgery (MIS) for pancreatic cancer has become very popular in modern pancreatic surgery. Evidence of the benefits of an MI approach are increasing thanks to prospective studies and randomized controlled studies.Areas covered: Agreement is lacking regarding the oncological feasibility of MIS for pancreatic cancer. Therefore, we performed a systematic review focusing on MIS for cancer of the head, body or tail of the pancreas. A total of 5237 studies were identified. After paper screening, 44 studies (22 on MI-pancreaticoduodenectomy and 22 on MI-distal pancreatectomy) met the eligibility criteria for the present review. The mean morbidity and mortality rates after MIPD were 31% and 4.9%, while overall complication and mortality rates were 32,5% and 1%. Median overall survival after MIPD and MIDP was 21.9 and 29.8 months, respectively. Both surgical and oncological outcomes were comparable to the open approach.Expert opinion: MIS offers advantages to the surgeon thanks to the high definition of the surgical field and the freedom of fine movement of the robot but should be considered only in selected patients and in high volume centers. Further studies are needed to prove the intraoperative and postoperative advantages of MIS compared to open surgery.

Keywords: Minimally invasive surgery; distal pancreatectomy; laparoscopic surgery; pancreas; pancreatoduodenectomy; robotic surgery; total pancreatectomy.