Elsevier

Surgery

Volume 137, Issue 6, June 2005, Pages 597-605
Surgery

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

https://doi.org/10.1016/j.surg.2005.02.002Get rights and content

Background

The reported experience with laparoscopic pancreatic resections (LPR) remains limited to case reports or small series of patients.

Methods

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.

Results

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.

Conclusions

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.

Section snippets

Patients

From 1995 to 2002, 127 patients with pancreatic lesions were reviewed retrospectively in 25 European centers. The median annual experiences per center in open pancreatic resections was 15 patients (range, 3-99), and for laparoscopic pancreatic resections (LPR) the annual median was 3 patients (range, 1-29), with only 4 centers (16%) treating more than 10 patients (L.F.C., J.S.A., C.B., G.D.). The inclusion rate increased over the study period (Figure). Patient, tumor size and type, and

Demographics

The median patient age was 52 years (range, 8-80 years); 68.5% were female. Fourteen patients (11%) were classified ASA III, according to the American Society of Anesthesiologists physical status score.46

Disease

Pancreatic diseases selected for laparoscopic resection are detailed in Table I. All patients with serous cystadenoma were symptomatic or appeared macrocystic on preoperative imaging studies, suggesting mucinous cystadenoma. The neoplasm was solitary in 123 patients, and 4 patients had 2

Discussion

To the best of our knowledge, the present series of LPR is the largest reported to date. However, most surgeons still remain in their learning curve, something important to bear in mind when analyzing the present study. On the other hand, this series reflects the results of LPR in a broad spectrum of general surgeons, giving thus a true picture of the procedure.

The most common indications for LPR were presumed benign pancreatic diseases, such as insulinoma or localized neuroendocrine neoplasms

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