Laparoscopic Central Pancreatectomy

摘要

BACKGROUND: Central pancreatectomy is an alternative technique for benign or low-grade malignant tumors. Laparoscopic central pancreatectomy has been rarely performed, with only 48 cases reported in the English literature. The aim of this paper was to review all published cases together with 3 cases from our institution. METHODS: All published articles indexed on PubMed were included. Terms used were "laparoscopic central pancreatectomy" or "laparoscopic middle pancreatectomy." Variables studied were the operative time, the type of reconstruction, indications, the use of robotic or hand assistance, blood loss, transfusion, pancreatic fistula, hospital stay, follow-up, development of exocrine and/or endocrine insufficiency, morbidity, and mortality. RESULTS: A total of 51 patients were identified. Twenty-one patients underwent total laparoscopy (41.2%), 27 required robotic assistance (52.9%), one required hand assistance (1.9%), and there were 2 conversions. In 18 cases (35.3%), pancreatic reconstruction involved a Roux-en-Y pancreatojejunostomy, and in 32 cases, pancreatogastrostomy (62.7%). The mean operative time was 356 minutes. Blood loss was minimal in most cases, and only 1 patient required blood transfusion (1.9%). Mortality was nil, but morbidity was high, mainly because of pancreatic fistula (46%). The mean hospital stay was 13.8 days. All patients underwent laparoscopic central pancreatectomy for benign or low-grade neoplasms. The mean follow-up duration was 19.6 months (range, 2 to 48 mo). No patient presented exocrine or endocrine insufficiency. CONCLUSIONS: Laparoscopic central pancreatectomy is a feasible and useful technique for the removal of tumors located in the neck of the pancreas. There are very few centers performing this operation, and therefore, a literature review was necessary to identify its indications and technical possibilities, and to promote its use.