Minimally Invasive Surgery for Malignancies of the Gastrointestinal Tract: Pancreas - Contra Position

作者：Hartmann Daniel; Michalski Christoph W; Kleeff Joerg^*

来源：Viszeralmedizin, 2013, 29(6): 375-381.

DOI：10.1159/000357173

• Laparoscopy
• Minimally invasive procedures
• Robotic surgery
• Pancreaticoduodenectomy
• Distal pancreatic resection

Background: Surgical resection is the mainstay of treatment for a variety of pancreatic diseases. Open surgery is highly standardized and can be performed with low mortality and morbidity at tertiary referral centers. Recently, there has been an increasing number of reports on laparoscopic pancreatic resections. Method: In this article, we review the current literature on minimally invasive pancreatic surgery, including laparoscopic and robotic-assisted pancreaticoduodenectomies and laparoscopic distal pancreatic resections for chronic pancreatitis as well as benign and malignant tumors, and compare it to the respective open procedures. Results: Laparoscopic and robotic-assisted pancreaticoduodenectomies can only be applied in select cases, are technically demanding, and are associated with an increased incidence of pancreatic fistulas. Laparoscopic distal resections are safe procedures with a reduced length of hospital stay. However, they should mainly be considered for benign tumors. In oncological surgery, open resection is generally preferred. If a laparoscopic approach is chosen, excellent preoperative diagnosis is required. Conclusions: Even though laparoscopic pancreatic resections are useful in select cases, they will remain the exception rather than the standard of care in the coming years. A general switch to laparoscopic distal resections will probably not take place due to a lack of distinct advantages of the minimally invasive approach over the open procedures.

• 出版日期2013