Mushegh A Sahakyan1,2, Dyre Kleive3,4, Airazat M Kazaryan5,6,7,8, Davit L Aghayan6,3, Dejan Ignjatovic3,9, Knut Jørgen Labori4, Bård Ingvald Røsok4, Bjørn Edwin6,3,4. 1. Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. sahakyan.mushegh@gmail.com. 2. The Intervention Center, Oslo University Hospital, Rikshospitalet, 0027, Oslo, Norway. sahakyan.mushegh@gmail.com. 3. Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. 4. Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 5. Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. 6. The Intervention Center, Oslo University Hospital, Rikshospitalet, 0027, Oslo, Norway. 7. Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway. 8. Department of Faculty Surgery N2, I.M, Sechenov First Moscow State Medical University, Moscow, Russia. 9. Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway.
Abstract
PURPOSE: Extended resection is required for pancreatic adenocarcinoma infiltrating adjacent organs and structures. The role of laparoscopy in this setting is unclear. In this study, the outcomes of extended laparoscopic distal pancreatectomy (ELDP) for pancreatic body/tail adenocarcinoma were examined. METHODS: Perioperative and oncologic data were analyzed in patients undergoing laparoscopic distal pancreatectomy (LDP) for adenocarcinoma at Oslo University Hospital. ELDP was defined as suggested by the International Study Group for Pancreatic Surgery. The outcomes of ELDP were compared to those following standard LDP (SLDP). RESULTS: From August 2001 to June 2016, 460 consecutive patients underwent LDP for pancreatic neoplasms including 116 (25%) adenocarcinoma. SLDP and ELDP were applied in 78 and 31 patients, respectively. The adrenal gland (33%) and colon (21%) were the most frequently resected organs during ELDP. The latter was associated with larger tumor size (5.5 vs 4 cm, p = 0.03), longer operative time (236 vs 158 min, p = 0.001) and higher conversion rate (16 vs 3%, p = 0.019) compared with SLDP. Morbidity and 90-day mortality were similar. Median follow-up was 18 months. In patients with ductal adenocarcinoma, ELDP (n = 22) was associated with significantly shorter recurrence-free and overall survival than SLDP (n = 59) (6.2 vs 9.6 months, p = 0.047 and 12.9 vs 27 months, p < 0.01, respectively). CONCLUSION: Although technically challenging, ELDP is feasible in patients with adenocarcinoma providing acceptable surgical outcomes. ELDP for ductal adenocarcinoma is associated with worse prognosis than SLDP, while its potential benefits over palliative care deserve further scrutiny.
PURPOSE: Extended resection is required for pancreaticadenocarcinoma infiltrating adjacent organs and structures. The role of laparoscopy in this setting is unclear. In this study, the outcomes of extended laparoscopic distal pancreatectomy (ELDP) for pancreatic body/tail adenocarcinoma were examined. METHODS: Perioperative and oncologic data were analyzed in patients undergoing laparoscopic distal pancreatectomy (LDP) for adenocarcinoma at Oslo University Hospital. ELDP was defined as suggested by the International Study Group for Pancreatic Surgery. The outcomes of ELDP were compared to those following standard LDP (SLDP). RESULTS: From August 2001 to June 2016, 460 consecutive patients underwent LDP for pancreatic neoplasms including 116 (25%) adenocarcinoma. SLDP and ELDP were applied in 78 and 31 patients, respectively. The adrenal gland (33%) and colon (21%) were the most frequently resected organs during ELDP. The latter was associated with larger tumor size (5.5 vs 4 cm, p = 0.03), longer operative time (236 vs 158 min, p = 0.001) and higher conversion rate (16 vs 3%, p = 0.019) compared with SLDP. Morbidity and 90-day mortality were similar. Median follow-up was 18 months. In patients with ductal adenocarcinoma, ELDP (n = 22) was associated with significantly shorter recurrence-free and overall survival than SLDP (n = 59) (6.2 vs 9.6 months, p = 0.047 and 12.9 vs 27 months, p < 0.01, respectively). CONCLUSION: Although technically challenging, ELDP is feasible in patients with adenocarcinoma providing acceptable surgical outcomes. ELDP for ductal adenocarcinoma is associated with worse prognosis than SLDP, while its potential benefits over palliative care deserve further scrutiny.