Laparoscopic and Robotic Resection for Pancreatic Cancer

Abstract

Use of laparoscopic and robotic surgery for pancreaticoduodenectomy and distal pancreatectomy is gaining increasing acceptance and appears to be associated with decreased morbidity and patient hospital stays with comparable oncologic outcomes. Comparative effective analyses of laparoscopic to open pancreaticoduodenectomy have demonstrated significantly improved EBL in the laparoscopic group and comparable operative times and fistula rates between the two cohorts. In regard to a robotic approach to the Whipple, our institution has shown improved conversion rate and blood loss metrics with increased experience, and has shown comparable grade 3 and 4 complication rates of 10.6% and 12%, respectively, to the open approach. Several case-control studies and case series evaluating outcomes of RPDs have been performed and have shown that EBL and length of stay is significantly better in the RPD with no increase in operative mortality compared with the open cohort. None of the studies to date have demonstrated an improvement in overall morbidity, fistula rate, or operative time. The oncologic outcomes between the MIS and open approaches for distal pancreatectomy have been shown to be equivalent. Several case series describing laparoscopic and robotic distal pancreatectomies have shown comparable operative times, as well as morbidity and mortality rates with some benefit afforded by the robotic approach in regard to blood loss metrics. This chapter will review the relevant literature supporting the safety, feasibility, and comparative effectiveness studies of MIS pancreatectomy for pancreatic cancer.