Laparoscopic pancreatic resection: Results of a multicenter European study of 127 patients

• Published in: Surgery Vol. 137; no. 6; pp. 597 - 605
• Main Authors: Mabrut, Jean-Yves, Fernandez-Cruz, Laureano, Azagra, Juan Santiago, Bassi, Claudio, Delvaux, Georges, Weerts, Joseph, Fabre, Jean-Michel, Boulez, Jean, Baulieux, Jacques, Peix, Jean-Louis, Gigot, Jean-François, Member Group, under the auspices of the Hepatobiliary and Pancreatic Section (HBPS) of the Royal Belgian Society of Surgery, the Belgian Group for Endoscopic Surgery (BGES) and the Club Coelio
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-06-2005; Elsevier
• Subjects: Biological and medical sciences; Follow-Up Studies; General aspects; Humans; Laparoscopy - adverse effects; Length of Stay; Medical sciences; Neoplasm Recurrence, Local; Pancreatectomy - adverse effects; Pancreatic Neoplasms - surgery; Reoperation; Retrospective Studies; Treatment Outcome; Europe; Human; Medicine; Endoscopic surgery; Treatment; Multicenter study; European; Pancreas; Public health
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2005.02.002

The reported experience with laparoscopic pancreatic resections (LPR) remains limited to case reports or small series of patients.
A retrospective multicenter study was conducted in 25 European surgical centers concerning their experience with LPR. Detailed questionnaires were used, focusing on patients, tumors, operative data, and late outcome.
During the study period, 127 patients with presumed pancreatic neoplasms were enrolled in this series. Final diagnoses included benign pancreatic diseases in 111 patients (87%; insulinoma: 22, neuroendocrine neoplasm: 20, mucinous cystadenoma: 26, serous cystadenoma: 21, chronic pancreatitis: 11, others: 11), and 16 patients (13%) had malignant pancreatic diseases (insulinoma: 3, neuroendocrine neoplasm: 5, ductal adenocarcinoma: 4, cystadenocarcinoma: 2, renal metastases: 2). Five patients with presumed benign pancreatic disease had malignancy at final pathology. The median tumor size was 30 mm (range, 5-120 mm); 89% of tumors were located in the left pancreas. Laparoscopically successful procedures included 21 enucleations, 24 distal splenopancreatectomies, 58 distal pancreatectomies with splenic preservation, and 3 pancreatoduodenal resections. The overall conversion rate was 14%. There were no postoperative deaths. The rate of overall postoperative pancreatic-related complications was 31%, including a 17% rate of clinical pancreatic fistula. The surgical reoperation rate was 6.3%. In laparoscopically successful operations, the median postoperative hospital stay was 7 days (range, 3-67 days), decreased compared with patients requiring conversion to open pancreatectomy. During a median follow-up of 15 months (range, 3-47 months), 23% of the patients with pancreatic malignancies had tumor recurrence. Late outcome was satisfactory in all patients with benign diseases.
LPR is feasible and safe in selected patients with presumed benign and distal pancreatic tumors. The management of the pancreatic stump remains a challenge. The role of LPR for pancreatic malignancies remains controversial.