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Curative Laparoscopic Resection for Pancreatic Neoplasms : a Critical Analysis from One Single Institution
Laureano FernáNdez-Cruz*, Miguel Angel LóPez-Boado, Emiliano Astudillo, Salvador Navarro
Surgery, Hospital Clínic, Barcelona, Spain

Laparoscopic pancreatic surgery(LPS) has seen significant development but much of the knowledge refers to small and benign pancreatic tumors. Some have suggested that left-sided adenocarcinoma is a contraindication to laparoscopic resection.
Aim: To evaluate the feasibility, safety and long-term outcome of the laparoscopic approach in patients with benign, premalignant and overt malignant lesions of the pancreas. This study, currently, is the largest single centre experience worldwide.
Patients And Method: 114 consecutive patients underwent laparoscopic pancreatic surgery from April 1998 to November 2006. 20 patients with cysts or pseudocysts for acute and chronic pancreatitis, laparoscopic pancreatic drainage was performed, and were excluded in the analysis. The 94 patients were divided based on preoperative diagnosis. Group I, inflammatory tumors for chronic pancreatitis (7 patients). Group II, cystic pancreatic neoplasms (26 patients).Group III, Intraductual papillary mucinous neoplasms (8 patients), Group IV, Neuroendocrine pancreatic tumors (NET) (40 patients) and Group V ductal adenocarcinoma (13 patients). The median tumor size was 5.3 cm. Pathologic data include R0 or R1 resection (transection margins on the specimen were inked). Long-term outcomes were analysed by tumor recurrence and patient survival (median and free survival).
Results: The overall conversion rate was 6.3%. Spleen-preserving distal pancreatectomy (SPDP) was performed in 60% of patients, splenopancreatectomy in 23% and enucleation in 17% of patients. A blood transfusion was required in 5.3% of patients. There was no mortality. The overall complication rate was 26.5%. Overall pancreas related complications was 12.8% but 20% after laparoscopic tumor enucleation (p<0.05). The median hospital stay was 6 days and 8 days for benign and malignant disease respectively (p<0.05). In 23 patients (24%) with malignant disease the median number of nodes was 15, and 91% of specimens had negative tangential margins. 50% of malignant NET had tumor recurrence or liver metastasis 2 years after LPS. The median survival for ductal adenocarcinoma patients was 14 months.
Conclusions: This series demonstrates that LPS is feasible and safe in benign-appearing and malignant lesions. The benefits of minimally surgery were encountered in the short hospital stay and acceptable pancreas related complication in high risk patients. LPS can achieve negative tangential margins in a high percent of patients with malignant tumors. However the technique has not proven to be an improvement in terms of curing cancer by removing all N1 nodes.

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