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Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference

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Abstract

Background

Introduced more than 20 years ago, laparoscopic pancreatic surgery (LAPS) has not reached a uniform acceptance among HPB surgeons. As a result, there is no consensus regarding its use in patients with pancreatic neoplasms. This study, organized by the European Association for Endoscopic Surgery (EAES), aimed to develop consensus statements and clinical recommendations on the application of LAPS in these patients.

Methods

An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreatic surgery. Each panelist performed a critical appraisal of the literature and prepared evidence-based statements assessed by other panelists during Delphi process. The statements were further discussed during a one-day face-to-face meeting followed by the second round of Delphi. Modified statements were presented at the plenary session of the 24th International Congress of the EAES in Amsterdam and in a web-based survey.

Results

LAPS included laparoscopic distal pancreatectomy (LDP), pancreatoduodenectomy (LPD), enucleation, central pancreatectomy, and ultrasound. In general, LAPS was found to be safe, especially in experienced hands, and also advantageous over an open approach in terms of intraoperative blood loss, postoperative recovery, and quality of life. Eighty-five percent or higher proportion of responders agreed with the majority (69.5%) of statements. However, the evidence is predominantly based on retrospective case–control studies and systematic reviews of these studies, clearly affected by selection bias. Furthermore, no randomized controlled trials (RCTs) have been published to date, although four RCTs are currently underway in Europe.

Conclusions

LAPS is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. LDP is feasible and safe, performed in many centers, while LPD is limited to few centers. RCTs and registry studies are essential to proceed with the assessment of LAPS.

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Acknowledgements

The members of the EAES consensus conference study group are as follows:

Magomet E. Baichorov, MD1, Thijs De Rooij, BSc2, Cansu G. Genç, MD2, Sven-Petter Haugvik, MD, PhD3, Roman E. Izrailov, MD, PhD1, Arthur A. Khisamov, MD1, Santiago Sánchez-Cabús, MD, PhD4, Régis Souche, MD5, Jony Van Hilst, MD2.

1Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia.

2Department of surgery, Academic Medical Center, Amsterdam, the Netherlands.

3Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.

4Department of Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain.

5Department of Surgery and Liver Transplantation, Hopital Saint Eloi-Hopitaux Universitaires de Montpellier, Université de Montpellier, Montpellier, France.

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Authors and Affiliations

  1. The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, 0027, Norway

    Bjørn Edwin & Mushegh A. Sahakyan

  2. Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway

    Bjørn Edwin & Mushegh A. Sahakyan

  3. Department of Hepato-Pancreato-Billiary Sugery, Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Bjørn Edwin

  4. University Hospital Southampton, NHS Foundation Trust, Southampton, UK

    Mohammad Abu Hilal

  5. Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands

    Marc G. Besselink

  6. Department of Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy

    Marco Braga

  7. Department of Digestive Surgery, Hospital Saint-Eloi, Montpellier, France

    Jean-Michel Fabre

  8. Department of Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain

    Laureano Fernández-Cruz

  9. Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France

    Brice Gayet

  10. Institut des Systèmes Intelligents et Robotique (ISIR), Université Pierre et Marie Curie, Paris, France

    Brice Gayet

  11. Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea

    Song Cheol Kim

  12. Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia

    Igor E. Khatkov

  13. Faculty of Surgery No. 2, Moscow State University of Medicine and Dentistry, Moscow, Russia

    Igor E. Khatkov

Authors
  1. Bjørn Edwin
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  2. Mushegh A. Sahakyan
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  3. Mohammad Abu Hilal
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  4. Marc G. Besselink
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  5. Marco Braga
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  6. Jean-Michel Fabre
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  7. Laureano Fernández-Cruz
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  8. Brice Gayet
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  9. Song Cheol Kim
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  10. Igor E. Khatkov
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Consortia

EAES Consensus Conference Study Group

  • Magomet E. Baichorov
  • , Thijs De Rooij
  • , Cansu G. Genç
  • , Sven-Petter Haugvik
  • , Roman E. Izrailov
  • , Arthur A. Khisamov
  • , Santiago Sánchez-Cabús
  • , Régis Souche
  •  & Jony Van Hilst

Corresponding author

Correspondence to Mushegh A. Sahakyan.

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Disclosures

Drs. Bjørn Edwin, Mohammad Abu Hilal, Marco Braga, Jean-Michel Fabre, Laureano Fernandez-Cruz, Brice Gayet, Song Cheol Kim, Igor E. Khatkov and Mushegh A. Sahakyan have no conflicts of interest or financial ties to disclose. Dr. Marc G. Besselink is funded by Ethicon International.

Additional information

The full list of collaborator names from the EAES Consensus Conference Study Group are listed in the Acknowledgement Section at the end of the article.

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Edwin, B., Sahakyan, M.A., Abu Hilal, M. et al. Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference. Surg Endosc 31, 2023–2041 (2017). https://doi.org/10.1007/s00464-017-5414-3

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  • DOI: https://doi.org/10.1007/s00464-017-5414-3

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