Minimally invasive surgery for pancreatic cancer
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REVIEW ARTICLE
Minimally invasive surgery for pancreatic cancer Yoshihiro Miyasaka1,2 · Takao Ohtsuka1,3 · Masafumi Nakamura1 Received: 22 June 2020 / Accepted: 29 June 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Pancreatic cancer is the most lethal malignancy of the digestive organs. Although pancreatic resection is essential to radically cure this refractory disease, the multi-organ resection involved, as well as sequelae such as glucose tolerance insufficiency and severe complications impose a heavy burden on these patients. Since the late twentieth century, minimally invasive surgery has become more popular for the surgical management of digestive disease and pancreatic cancer. Minimally invasive pancreatic resection (MIPR), including pancreaticoduodenectomy and distal pancreatectomy, is now a treatment option for pancreatic cancer. Some evidence suggests that MIPR for pancreatic cancer provides comparable oncological outcomes to open surgery, with some advantages in perioperative outcomes. However, as this evidence is retrospective, prospective investigations, including randomized controlled trials, are necessary. Because neoadjuvant therapy for resectable or borderlineresectable pancreatic cancer and conversion surgery for initially unresectable pancreatic cancer has become more common, the feasibility of MIPR after neoadjuvant therapy or as conversion surgery requires further assessment. It is expected that progress in surgical techniques and devices, as well as the standardization of surgical procedures and widespread educational programs will improve the outcomes of MIPR. Keywords Pancreatic cancer · Pancreatic resection · Minimally invasive · Laparoscopic · Robotic
Introduction Pancreatic cancer is associated with a dismal prognosis and a 5-year survival rate of only 9% [1]. At the rate its incidence is increasing, it is anticipated that by 2030, it will be the second leading cause of cancer-related death [2]. Despite advances in chemotherapy and chemoradiotherapy, pancreatic resection is essential to cure pancreatic cancer. However, the multi-organ resection that pancreatic resection requires, together with glucose tolerance insufficiency and severe complications such as postoperative pancreatic fistula, impose a heavy burden on patients. In the 1970s,
* Masafumi Nakamura [email protected]‑u.ac.jp 1
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3‑1‑1 Maidashi, Higashi‑ku, Fukuoka 812‑8582, Japan
2
Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan
3
Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Kagoshima, Japan
the mortality rate after pancreaticoduodenectomy (PD) was approximately 20%, but progress in surgical procedures and devices, combined with better postoperative management, have decreased the rate to around 3% [3–5]. During the late twentieth century, minimally invasive surgery (MIS); namely, laparoscopic and robotic surgery, enc
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