Email this article Laparoscopic interventions in the pancreas: an 11-year experience of a specialized center
- Authors: Khatkov I.E.1, Tsvirkun V.V.1, Izrailov R.E.1, Vasnev O.S.1, Tyutyunnik P.S.1, Mikhnevich M.V.1, Baychorov M.E.1, Andrianov A.V.1
-
Affiliations:
- The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department
- Issue: Vol 46, No 6 (2018)
- Pages: 640-647
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/903
- DOI: https://doi.org/10.18786/2072-0505-2018-466-640-647
- ID: 903
Cite item
Full Text
Abstract
Introduction: Due to anatomical and functional specifics of the pancreas, its surgery emerged somewhat later than that of other areas of abdominal surgery, i.e. in the last 25 to 30 years of the last century. Minimally invasive laparoscopic interventions on the pancreas are still used insufficiently.
Aim: To evaluate an 11-year experience of various laparoscopic interventions in the pancreas accumulated by one surgical team.
Materials and methods: From November 2007 to May 2018, 371 patients (153 male and 218 female) underwent various laparoscopic pancreatic procedures for cancers of the biliopancreatoduodenal zone (n = 260), benign pancreatic tumors (n = 37), and chronic pancreatitis (n = 74). We performed 245 laparoscopic pancreaticoduodenal resections, 52 laparoscopic distal resections (LDR), 35 laparoscopic Frey procedures (FP), 18 laparoscopic total duodenopancreatectomies, 8 laparoscopic longitudinal pancreaticojejunostomies (LLPJ), 8 laparoscopic cystoenterostomies (LCE), 3 enucleations, and 2 Beger procedures (BP).
Results: Laparoscopic gastropancreatoduodenal resection was performed in 197 (80.4%) cases and pylorus preserving pancreatoduodenal resection in 48 (19.6%) cases. The duration of the procedures was 412 ± 101 minutes, with blood loss volume of 220 ± 152 ml, and postoperative hospital stay of 19 ± 9 days. LDR was done laparoscopically in 50 (96.2%) patients; its duration was 228 ± 74 minutes, blood loss 40 ± 50 ml, and postoperative hospital stay 8 ± 5 days. FP, LLPJ, BP, and LCE were performed laparoscopically in 53 (93%) cases. FP lasted for 436 ± 95, LLPJ for 406 ± 82, BP for 585 ± 134, and LCE for 327 ± 90 minutes. The respective volumes of blood loos were 227 ± 217 mL in FP, 150 ± 156 mL in LLPJ, 175 ± 106 mL in BP, and 60 ± 90 mL in LCE. The postoperative hospital stay lasted for 8 ± 4 days after FP, 9 ± 7 days after LLPJ, 4.5 ± 0.7 days after BP, and 10 ± 9 days after LCE.
Conclusion: Laparoscopic surgery of the pancreas is associated with minimal blood loss, absence of wound infection, and more rapid patient activation and rehabilitation. Compliance with the necessary requirements to implementation of laparoscopic technologies in high-volume centers should improve surgical results.
About the authors
I. E. Khatkov
The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department
Email: fake@neicon.ru
Igor E. Khatkov – Member-Correspondent of Russian Academy of Sciences, MD, PhD, Professor, Director.
86 Shosse Entuziastov, Moscow, 111123
Russian FederationV. V. Tsvirkun
The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department
Email: fake@neicon.ru
Victor V. Tsvirkun – MD, PhD, Professor, Chief Research Fellow.
86 Shosse Entuziastov, Moscow, 111123
Russian FederationR. E. Izrailov
The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department
Email: fake@neicon.ru
Roman E. Izrailov – MD, PhD, Head of the Department of Innovative Surgery.
86 Shosse Entuziastov, Moscow, 111123
Russian FederationO. S. Vasnev
The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department
Email: fake@neicon.ru
Oleg S. Vasnev – MD, PhD, Head of the Department of High-Tech Surgery and Endoscopic Surgery.
86 Shosse Entuziastov, Moscow, 111123
Russian FederationP. S. Tyutyunnik
The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department
Email: fake@neicon.ru
Pavel S. Tyutyunnik – MD, Research Fellow, Department of High-Tech Surgery and Endoscopic Surgery.
86 Shosse Entuziastov, Moscow, 111123
Russian FederationM. V. Mikhnevich
The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department
Email: fake@neicon.ru
Mikhail V. Mikhnevich – MD, Research Fellow, Department of High-Tech Surgery and Endoscopic Surgery.
86 Shosse Entuziastov, Moscow, 111123
Russian FederationM. E. Baychorov
The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department
Email: fake@neicon.ru
Magomed E. Baychorov – MD, Research Fellow, Department of High-Tech Surgery and Endoscopic Surgery.
86 Shosse Entuziastov, Moscow, 111123
Russian FederationA. V. Andrianov
The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department
Author for correspondence.
Email: andnov2@gmail.com
Aleksey V. Andrianov – MD, Research Fellow, Department of High-Tech Surgery and Endoscopic Surgery.
9/7–209 Teply Stan ul., Moscow, 117465, tel.: +7 (903) 140 16 82
Russian FederationReferences
- Сарр МГ, ред. Поджелудочная железа. В: Клавьен П-А, Сарр МГ, Фонг Ю, ред. Атлас хирургии верхних отделов желудочнокишечного тракта, печени, поджелудочной железы и желчных путей. М.: Издательство Панфилова; БИНОМ. Лаборатория знаний; 2009. с. 724–928.
- Гальперин ЭИ, Дюжева ТГ, ред. Лекции по гепатопанкреатобилиарной хирургии. М.: Видар-М; 2011. 536 с.
- Национальные клинические рекомендации по хирургическому лечению больных хроническим панкреатитом. 2013. 43 с.
- Ammori BJ, Baghdadi S. Minimally invasive pancreatic surgery: the new frontier? Curr Gastroenterol Rep. 2006;8(2): 132–42.
- Björnsson B, Sandström P. Laparoscopic distal pancreatectomy for adenocarcinoma of the pancreas. World J Gastroenterol. 2014;20(37): 13402–11. doi: 10.3748/wjg.v20.i37.13402.
- Briggs CD, Mann CD, Irving GR, Neal CP, Peterson M, Cameron IC, Berry DP. Systematic review of minimally invasive pancreatic resection. J Gastrointest Surg. 2009;13(6): 1129–37. doi: 10.1007/s11605-008-0797-z.
- Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg. 2014;260(4): 633–8. doi: 10.1097/SLA.0000000000000937.
- Qin H, Qiu J, Zhao Y, Pan G, Zeng Y. Does minimally-invasive pancreaticoduodenectomy have advantages over its open method? A meta-analysis of retrospective studies. PLoS One. 2014;9(8):e104274. doi: 10.1371/journal.pone.0104274.
- Lei P, Wei B, Guo W, Wei H. Minimally invasive surgical approach compared with open pancreaticoduodenectomy: a systematic review and meta-analysis on the feasibility and safety. Surg Laparosc Endosc Percutan Tech. 2014;24(4): 296–305. doi: 10.1097/SLE.0000000000000054.
- Bloechle C, Izbicki JR, Knoefel WT, Kuechler T, Broelsch CE. Quality of life in chronic pancreatitis – results after duodenum-preserving resection of the head of the pancreas. Pancreas. 1995;11(1): 77–85.
- Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8(5): 408–10.
- Kantor O, Talamonti MS, Sharpe S, Lutfi W, Winchester DJ, Roggin KK, Bentrem DJ, Prinz RA, Baker MS. Laparoscopic pancreaticoduodenectomy for adenocarcinoma provides short-term oncologic outcomes and long-term overall survival rates similar to those for open pancreaticoduodenectomy. Am J Surg. 2017;213(3): 512–5. doi: 10.1016/j.amjsurg.2016.10.030.
- Wang S, Shi N, You L, Dai M, Zhao Y. Minimally invasive surgical approach versus open procedure for pancreaticoduodenectomy: A systematic review and meta-analysis. Medicine (Baltimore). 2017;96(50):e8619. doi: 10.1097/MD.0000000000008619.
- Sharpe SM, Talamonti MS, Wang E, Bentrem DJ, Roggin KK, Prinz RA, Marsh RD, Stocker SJ, Winchester DJ, Baker MS. The laparoscopic approach to distal pancreatectomy for ductal adenocarcinoma results in shorter lengths of stay without compromising oncologic outcomes. Am J Surg. 2015;209(3): 557– 63. doi: 10.1016/j.amjsurg.2014.11.001.
- Kendrick ML, Sclabas GM. Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford). 2011;13(7): 454–8. doi: 10.1111/j.1477-2574.2011.00323.x.
- Хатьков ИЕ, Цвиркун ВВ, Агапов ВК, Израилов РЕ, Багдатьева МГ, Паклина ОВ, Кулезнева ЮВ. Лапароскопическая панкреатодуоденальная резекция. Анналы хирургической гепатологии. 2007;12(4): 26–30.
- de Rooij T, Besselink MG, Shamali A, Butturini G, Busch OR, Edwin B, Troisi R, Fernández-Cruz L, Dagher I, Bassi C, Abu Hilal M; DIPLOMA trial group. Pan-European survey on the implementation of minimally invasive pancreatic surgery with emphasis on cancer. HPB (Oxford). 2016;18(2): 170–6. doi: 10.1016/j.hpb.2015.08.005.
- Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg. 2012;255(6): 1048–59. doi: 10.1097/SLA.0b013e318251ee09.
- Yoon YS, Lee KH, Han HS, Cho JY, Jang JY, Kim SW, Lee WJ, Kang CM, Park SJ, Han SS, Ahn YJ, Yu HC, Choi IS. Effects of laparoscopic versus open surgery on splenic vessel patency after spleen and splenic vessel-preserving distal pancreatectomy: a retrospective multicenter study. Surg Endosc. 2015;29(3): 583–8. doi: 10.1007/s00464-014-3701-9.
- Yamada S, Fujii T, Kawai M, Shimokawa T, Nakamura M, Murakami Y, Satoi S, Eguchi H, Nagakawa Y, Kodera Y, Yamaue H. Splenic vein resection together with the pancreatic parenchyma versus separated resection after isolation of the parenchyma during distal pancreatectomy (COSMOS-DP trial): study protocol for a randomised controlled trial. Trials. 2018;19(1): 369. doi: 10.1186/s13063-0182756-7.
- Nakata K, Shikata S, Ohtsuka T, Ukai T, Miyasaka Y, Mori Y, Velasquez VVDM, Gotoh Y, Ban D, Nakamura Y, Nagakawa Y, Tanabe M, Sahara Y, Takaori K, Honda G, Misawa T, Kawai M, Yamaue H, Morikawa T,Kuroki T, Mou Y, Lee WJ, Shrikhande SV, Tang CN, Conrad C, Han HS, Chinnusamy P, Asbun HJ, Kooby DA, Wakabayashi G, Takada T, Yamamoto M, Nakamura M. Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis. J Hepatobiliary Pancreat Sci. Forthcoming 2018. doi: 10.1002/jhbp.569.
- Sharpe SM, Talamonti MS, Wang CE, Prinz RA, Roggin KK, Bentrem DJ, Winchester DJ, Marsh RD, Stocker SJ, Baker MS. Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: a comparison of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy from the National Cancer Data Base. J Am Coll Surg. 2015;221(1): 175–84. doi: 10.1016/j.jamcollsurg.2015.04.021.
- Kurian MS, Gagner M. Laparoscopic side-toside pancreaticojejunostomy (Partington-Rochelle) for chronic pancreatitis. J Hepatobiliary Pancreat Surg. 1999;6(4): 382–6.
- Cooper MA, Datta TS, Makary MA. Laparoscopic Frey procedure for chronic pancreatitis. Surg Laparosc Endosc Percutan Tech. 2014;24(1):e16–20. doi: 10.1097/SLE.0b013e31828f6edf.
- Khaled YS, Ammori BJ. Laparoscopic lateral pancreaticojejunostomy and laparoscopic Berne modification of Beger procedure for the treatment of chronic pancreatitis: the first UK experience. Surg Laparosc Endosc Percutan Tech. 2014;24(5):e178–82. doi: 10.1097/SLE.0b013e31829ce803.
- Tantia O, Jindal MK, Khanna S, Sen B. Laparoscopic lateral pancreaticojejunostomy: our experience of 17 cases. Surg Endosc. 2004;18(7): 1054–7. doi: 10.1007/s00464-003-9210-x.
Supplementary files
