Laparoscopic pancreatic resection: the past, present, and future

Area of Science:

• Minimally Invasive Surgery
• Gastrointestinal Surgery
• Surgical Oncology

Background:

• Laparoscopic techniques have increasingly been adopted for various pancreatic surgeries since the early 1990s.
• These procedures address conditions such as chronic pancreatitis, pancreatic trauma, congenital hyperinsulinism, and pancreatic neoplasms.
• Laparoscopic approaches, including en bloc lymph node dissection, are utilized for invasive pancreatic carcinomas.

Purpose of the Study:

• To review the current applications and outcomes of laparoscopic pancreatic resections.
• To evaluate the benefits and limitations of laparoscopic techniques for both distal and proximal pancreatectomies.
• To identify areas requiring further investigation, particularly for complex procedures and long-term results in pancreatic cancer.

Main Methods:

• Review of existing literature, including retrospective analyses, collective series, and case reports on laparoscopic pancreatic surgery.
• Analysis of outcomes for laparoscopic distal pancreatectomies (with/without spleen preservation).
• Assessment of the feasibility and challenges of laparoscopic proximal pancreatectomies (including pancreaticoduodenectomy and duodenum-preserving resections).

Main Results:

• Laparoscopic distal pancreatectomies show potential benefits like reduced postoperative pain, shorter hospital stays, quicker recovery, and improved cosmesis.
• Long-term outcomes for laparoscopic resections of invasive pancreatic cancer are not yet well-defined.
• Laparoscopic proximal pancreatectomies, while technically feasible in experienced hands, present significant reconstruction challenges and are not yet widely practicable.

Conclusions:

• Laparoscopic distal pancreatectomy appears to offer significant patient advantages, but prospective randomized trials are needed for validation.
• Laparoscopic proximal pancreatectomies remain controversial due to technical complexities and the need to establish clear clinical benefits and safety.
• Further research and robust evidence are essential to support the broader adoption of advanced laparoscopic techniques in complex pancreatic surgery.