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World J Gastroenterol. Oct 7, 2014; 20(37): 13402-13411
Published online Oct 7, 2014. doi: 10.3748/wjg.v20.i37.13402
Laparoscopic distal pancreatectomy for adenocarcinoma of the pancreas
Bergthor Björnsson, Per Sandström
Bergthor Björnsson, Per Sandström, Department of Surgery, County Council of Östergötland and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 58185 Linköping, Sweden
Author contributions: Björnsson B and Sandström P designed the research, performed the research and wrote the paper.
Correspondence to: Bergthor Björnsson, MD, Department of Surgery, County Council of Östergötland and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, 58185 Linköping, Sweden. bergthor.bjornsson@lio.se
Telephone: +46-10-1030000 Fax: +46-10-1033570
Received: November 16, 2013
Revised: February 11, 2014
Accepted: April 21, 2014
Published online: October 7, 2014
Abstract

Since the first report on laparoscopic distal pancreatectomy (LDP) appeared in the 1990s, the procedure has been performed increasingly frequently to treat both benign and malignant lesions of the pancreas. Many earlier publications have shown LDP to be a good alternative to open distal pancreatectomy for benign lesions, although this has never been studied in a prospective, randomized manner. The evidence for the use of LDP to treat adenocarcinoma of the pancreas is not as well established. The purpose of this review is to evaluate the current evidence for LDP in cases of pancreatic adenocarcinoma. We conducted a review of English language publications reporting LDP results between 1990 and 2013. All studies reporting results in patients with histologically proven pancreatic adenocarcinoma were included. Thirty-nine publications were found and included in the results for a total of 309 cases of pancreatic adenocarcinoma (potential double publications were not eliminated). Most LDP procedures are performed in selected cases and generally involve smaller tumors than open distal pancreatectomy (ODP) procedures. Some of the papers report unselected cases and include procedures on larger tumors. The number of lymph nodes harvested using LDP is comparable to the number obtained with ODP, as is the frequency of R0 resections. Current data suggest that similar short term oncological results can be obtained using LDP as those obtained using ODP.

Keywords: Adenocarcinoma of the pancreas, Laparoscopy, Distal pancreatectomy, Surgical margins, Pancreatic resection

Core tip: There are about 300 published cases of laparoscopic distal pancreatectomy for adenocarcinoma reported in the English literature. None of these cases has been included in randomized prospective work and it is doubtful that such a study will ever be conducted. This objective of this review was to evaluate the appropriateness of laparoscopic distal pancreatectomy as treatment for pancreatic adenocarcinoma. The results suggest that this minimally invasive technique may be safely applied to treat the disease in addition to the other more established indications for the operation.