Minimally invasive surgical techniques for pancreatic cancer: ready for prime time?
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Topics from International Symposium on Pancreas Cancer in Kyoto
Minimally invasive surgical techniques for pancreatic cancer: ready for prime time? Marc G. Mesleh • John A. Stauffer Horacio J. Asbun
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Published online: 17 April 2013 Ó Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer Japan 2013
Abstract Background Minimally invasive surgical techniques for pancreatic cancer are being applied with increasing frequency. With support of the literature, the location of the tumor within the pancreas is the factor which determines if these techniques can be safely used routinely by pancreatic surgeons. Methods Literature supporting minimally invasive techniques for all types of resections for pancreatic cancer was reviewed. Results Multiple meta-analysis regarding laparoscopic distal pancreatectomy all support the routine use of laparoscopy for these lesions. There are several case series describing the safety and efficacious use of laparoscopy in pancreaticoduodenectomy, and results have been promising in these highly specialized centers. Conclusions The location of the tumor within the pancreas remains the most critical factor in the use of laparoscopy as the standard of care. Lesions in the body and tail, which are readily resected with a distal or subtotal pancreatectomy should be performed laparoscopically unless there is a clear reason why not to do so. Lesions in the head of the pancreas have been shown to be removed safely and effectively with laparoscopy. However, the technical skills necessary and the ability to teach these to trainees are the limiting factors to widespread use. Further series are necessary to assess if the laparoscopic approach to pancreaticoduodenectomy will play a similar role as the one it plays in the surgical treatment for distal lesions.
M. G. Mesleh J. A. Stauffer H. J. Asbun (&) Division of General Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA e-mail: [email protected]
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Keywords Laparoscopy Distal pancreatectomy Pancreaticoduodenectomy Pancreatic cancer
Introduction Pancreatic cancer has significant prevalence and incidence within the USA and throughout the world. In 2012, there were an estimated 44,000 new cases of pancreatic cancer [1]. More striking is that fact that there were[37,000 deaths from pancreatic cancer in 2012, and its associated 5-year survival is a mere 6 %. The dismal prognosis is caused by the fact that approximately 50 % of patients have distant disease at presentation, and an additional 25 % present with locally advanced disease. Due to the stigma of the disease and the complexity of the surgical resection, of the remaining 25 % who are resectable at presentation, half of these patients are never seen by a surgeon, or refuse an operation [2]. The misconceptions surrounding pancreatic surgery and its associated morbidity are beginning to change. As surgical skill and post-operative management have become more sophisticated, the morbidity and mortality associated with pancreatic surgery has dec
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