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Technical aspects of laparoscopic distal pancreatectomy for benign and malignant disease: review of the literature

Technical aspects of laparoscopic distal pancreatectomy for benign and malignant disease: review of the literature
Technical aspects of laparoscopic distal pancreatectomy for benign and malignant disease: review of the literature
Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. The most obvious benefits of a laparoscopic approach to distal pancreatectomy include earlier recovery and shorter hospital stay. Spleen-preserving distal pancreatectomy should be attempted in case of benign disease. Spleen preservation can be achieved preferably by preserving the splenic vessels (Kimura technique), but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and left gastroepiploic artery (Warshaw technique). Several studies have suggested a higher rate of spleen preservation with laparoscopy. The radical antegrade modular pancreatosplenectomy has become mainstay for treating pancreatic cancer and can be performed laparoscopically as well. Evidence on the feasibility and safety of laparoscopic distal pancreatectomy for cancer is scarce. Despite the obvious advantages of laparoscopic surgery, postoperative morbidity remains relatively high, mainly because of the high incidence of pancreatic fistula. For decades, surgeons have tried to prevent these fistulas but to date no strategy has been confirmed to be effective in 2 consecutive randomized studies. Pragmatic multicenter studies focusing on technical aspects of laparoscopic distal pancreatectomy are lacking and should be encouraged.
1687-6121
1-9
de Rooij, T.
f2e3148e-3b0e-4573-99d0-fc4211d687a1
Sitarz, R.
7fd31e01-5658-457a-a6b0-166cff08a2ad
Busch, O.R.
6a2f62fe-57e5-421a-908a-e26b2d75d0ac
Besselink, M.G.
701b782f-4e07-4b9f-a75f-af28a6aa8cd9
Abu Hilal, M.
384e1c60-8519-4eed-8e92-91775aad4c47
de Rooij, T.
f2e3148e-3b0e-4573-99d0-fc4211d687a1
Sitarz, R.
7fd31e01-5658-457a-a6b0-166cff08a2ad
Busch, O.R.
6a2f62fe-57e5-421a-908a-e26b2d75d0ac
Besselink, M.G.
701b782f-4e07-4b9f-a75f-af28a6aa8cd9
Abu Hilal, M.
384e1c60-8519-4eed-8e92-91775aad4c47

de Rooij, T., Sitarz, R., Busch, O.R., Besselink, M.G. and Abu Hilal, M. (2015) Technical aspects of laparoscopic distal pancreatectomy for benign and malignant disease: review of the literature. Gastroenterology Research and Practice, 2015 (472906), 1-9. (doi:10.1155/2015/472906). (PMID:26240565)

Record type: Article

Abstract

Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. The most obvious benefits of a laparoscopic approach to distal pancreatectomy include earlier recovery and shorter hospital stay. Spleen-preserving distal pancreatectomy should be attempted in case of benign disease. Spleen preservation can be achieved preferably by preserving the splenic vessels (Kimura technique), but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and left gastroepiploic artery (Warshaw technique). Several studies have suggested a higher rate of spleen preservation with laparoscopy. The radical antegrade modular pancreatosplenectomy has become mainstay for treating pancreatic cancer and can be performed laparoscopically as well. Evidence on the feasibility and safety of laparoscopic distal pancreatectomy for cancer is scarce. Despite the obvious advantages of laparoscopic surgery, postoperative morbidity remains relatively high, mainly because of the high incidence of pancreatic fistula. For decades, surgeons have tried to prevent these fistulas but to date no strategy has been confirmed to be effective in 2 consecutive randomized studies. Pragmatic multicenter studies focusing on technical aspects of laparoscopic distal pancreatectomy are lacking and should be encouraged.

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Accepted/In Press date: 7 June 2015
Published date: July 2015
Organisations: Cancer Sciences

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Local EPrints ID: 400313
URI: http://eprints.soton.ac.uk/id/eprint/400313
ISSN: 1687-6121
PURE UUID: bd940dd0-214f-4a2b-b55b-1697df98f6db

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Date deposited: 14 Sep 2016 10:46
Last modified: 15 Mar 2024 02:14

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Contributors

Author: T. de Rooij
Author: R. Sitarz
Author: O.R. Busch
Author: M.G. Besselink
Author: M. Abu Hilal

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