PancreasLaparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: Long-term oncologic outcomes after standard resection
Section snippets
Design and patients
The study population comprised consecutive patients with PDAC who underwent LDP at the Oslo University Hospital-Rikshospitalet ([OUH] Oslo, Norway) and the Asan Medical Centre ([AMC] Seoul, South Korea) from January 2002 to March 2016. Patients with intraductal papillary mucinous and adenosquamous carcinoma were excluded due to different tumor characteristics and prognosis.14, 15 Neoadjuvant treatment was not a part of the standard management scheme in patients with resectable PDAC, but
Operative and short-term oncologic outcomes
Of the 262 patients with PDAC who underwent LDP between January 2002 and March 2016, 207 (79%) underwent SLDP, while 47 (17.9%) underwent extended LDP due to tumor invasion to adjacent organ(s). Eight (3.1%) patients underwent CLDP for distant metastases of PDAC detected at the time of operation.
Demographics, clinical characteristics, and perioperative outcomes of patients undergoing SLDP are presented in Table I. One hundred forty-four patients were operated at AMC, and 63 at OUH. Six (2.9%)
Discussion
This study suggests that SLDP is associated with acceptable long-term oncologic outcomes in patients with PDAC. Nevertheless, more than half of patients were diagnosed with tumor recurrence on a median follow-up period of 18 months. Liver metastases and locoregional recurrence were the most common of types of tumor relapse, which is consistent with previous reports22, 23; however, these studies focused mainly on pancreatoduodenectomy, whereas similar data after LDP are limited to small case
References (56)
- et al.
A comparative study of laparoscopic vs. open distal pancreatectomy for left-sided ductal adenocarcinoma: a propensity score-matched analysis
J Am Coll Surg
(2015) - et al.
Laparoscopic versus open distal pancreatectomy for ductal adenocarcinoma: a systematic review and meta-analysis
J Gastrointest Surg
(2015) - et al.
Laparoscopic distal pancreatectomy employing radical en bloc procedure for adenocarcinoma: technical details and outcomes
Surgery
(2015) - et al.
Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the International Study Group for Pancreatic Surgery (ISGPS)
Surgery
(2014) - et al.
Pan-European survey on the implementation of minimally invasive pancreatic surgery with emphasis on cancer
HPB (Oxford)
(2016) - et al.
Laparoscopic resection of exocrine carcinoma in central and distal pancreas results in a high rate of radical resections and long postoperative survival
Surgery
(2012) - et al.
Follow-up after curative surgery for pancreatic ductal adenocarcinoma: asymptomatic recurrence is associated with improved survival
Eur J Surg Oncol
(2013) - et al.
Postoperative pancreatic fistula: an international study group (ISGPF) definition
Surgery
(2005) - et al.
Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings
J Gastrointest Surg
(2006) - et al.
R1 resection in pancreatic cancer has significant impact on long-term outcome in standardized pathology modified for routine use
Surgery
(2012)
Survival effect of tumor size and extrapancreatic extension in surgically resected pancreatic cancer: proposal for improved T classification
Human Pathol
Is tumour size an underestimated feature in the current TNM system for malignancies of the pancreatic head?
HPB (Oxford)
Proposed preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after surgical resection: a multi-center retrospective study
Pancreatology
Predicting patient survival after pancreaticoduodenectomy for malignancy: histopathological criteria based on perineural infiltration and lymphovascular invasion
HPB (Oxford)
A nationwide comparison of laparoscopic and open distal pancreatectomy for benign and malignant disease
J Am Coll Surg
Number of metastatic lymph nodes, but not lymph node ratio, is an independent prognostic factor after resection of pancreatic carcinoma
J Am Coll Surg
The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer
J Gastrointest Surg
Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators
J Gastrointest Surg
Serum CA19-9 is a significant predictor among preoperative parameters for early recurrence after resection of pancreatic adenocarcinoma
J Gastrointest Surg
CA 19-9 level as indicator of early distant metastasis and therapeutic selection in resected pancreatic cancer
Int J Radiat Oncol Biol Phys
Staging for locally advanced pancreatic cancer
Eur J Surg Oncol
Survival of patients with resectable pancreatic cancer who received neoadjuvant therapy
Surgery
Role of neoadjuvant therapy in the multimodality treatment of older patients with pancreatic cancer
J Am Coll Surg
Neoadjuvant therapy versus upfront surgical strategies in resectable pancreatic cancer: a Markov decision analysis
Eur J Surg Oncol
Pancreatic ductal adenocarcinoma: risk factors, screening, and early detection
World J Gastroenterol
Variant profiling of candidate genes in pancreatic ductal adenocarcinoma
Clin Chem
Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: time for a randomized controlled trial? Results of an all-inclusive national observational study
Ann Surg
Laparoscopic radical 'no-touch' left pancreatosplenectomy for pancreatic ductal adenocarcinoma: technique and results
Surg Endosc
Cited by (22)
Minimally Invasive Techniques for Pancreatic Resection
2021, Surgical Oncology Clinics of North AmericaCitation Excerpt :Although the adoption of MIS has been slow for pancreaticoduodenectomy, it has been more rigorous for distal pancreatectomy because of a relatively less challenging dissection and the lack of a reconstruction phase. There is a plethora of analyses supporting the adoption of this approach, 2 of which are randomized trials and are presented below.21–40 The LEOPARD trial was a multicenter patient-blinded, randomized controlled superiority trial performed in 14 centers of the Dutch Pancreatic Cancer Group.
Laparoscopic distal pancreatectomy in patients with poor physical status
2021, HPBCitation Excerpt :LDP is the standard approach in the treatment of lesions in the pancreatic body and tail at our institution. Operative technique and perioperative management of these patients have been described previously.12–14 Open distal pancreatectomy has been performed in a very small proportion of patients (<4%), mostly in cases requiring complex vascular reconstructions.
Variation in use of open and laparoscopic distal pancreatectomy and associated outcome metrics in a universal health care system
2019, PancreatologyCitation Excerpt :Analyses are done for variations between each region. As the SouthEast region represents the largest population (about half the patients in the cohort) and has had a long-standing interest in laparoscopic pancreatic surgery [15–17], analysis were also done for differences between the SouthEast region and the other regions combined. The population data for Norway and for each RHA catchment area (Fig. 1) are derived from Norway Statistics (www.ssb.no) at the time of study period.
Laparoscopic approach of the left side of the pancreas
2019, Cirugia EspanolaMinimally invasive versus open distal pancreatectomy for pancreatic cancer: a review of the literature
2022, Laparoscopic Surgery
Drs Song Cheol Kim and Mushegh Sahakyan share the first authorship on this manuscript.