Minimally invasive pancreaticoduodenectomy with venous resection: results of a systematic review

Abstract

Aim: Growing experience with minimally invasive pancreaticoduodenectomy (PD) has led surgeons to expand the indications for this approach. We systematically reviewed the literature on minimally invasive PD with venous resection.

Methods: The EMBASE, MEDLINE, and Cochrane central databases were systematically searched for articles from January 2010 to January 2020 describing cases of PD with venous resection. The search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcomes were feasibility and conversion rate. Secondary outcomes were morbidity, mortality, blood loss and 1-year survival.

Results: The literature search found 9 studies reporting 140 patients undergoing PD with venous resection. Sixty-six PDs were performed robotically (47.1%). The conversion rate ranged from 0% to 55%, blood loss ranged from 200 to 842 mL, and operative time ranged from 397 to 518 min. There were 82 lateral (58.5%) and 18 segmental (12.8%) PDs with venous resection. One patient had an associated arterial resection (0.7%). A graft was used for venous reconstruction in 28 patients (20%). Eight deaths (5.7%) were reported postoperatively.

Conclusion: Minimally invasive pancreatectomies with synchronous lateral venous resections are increasingly reported by highly experienced surgeons in high-volume institutions. Further experience is needed to validate this approach and prove its advantages over open surgery.

Keywords

Pancreatectomy / vascular resection / venous resection / arterial resection / locally advanced tumours

References

[1] Gagner M.Laparoscopic pylorus-preserving pancreatoduodenectomy..Surg Endosc1994;8:408-10

[2] van Hilst J,Bosscha K,van Dieren S.Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial..Lancet Gastroenterol Hepatol2019;4:199-207

[3] Boggi U,De Lio N,Vistoli F.Feasibility of robotic pancreaticoduodenectomy..Br J Surg2013;100:917-25

[4] Zureikat AH,Zenati MS,Boone BA.500 Minimally invasive robotic pancreatoduodenectomies: one decade of optimizing performance..Ann Surg2021;273:966-72

[5] Stauffer JA,Villacreses D,Johnson E.Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution..Surg Endosc2017;31:2233-41

[6] Boggi U,Vistoli F,Amorese G.Laparoscopic robot-assisted pancreas transplantation: first world experience..Transplantation2012;93:201-6

[7] Giulianotti P,Sbrana F,Jeon H.Robotic transabdominal kidney transplantation in a morbidly obese patient..Am J Transplant2010;10:1478-82

[8] Giulianotti PC,Addeo P,Coratti A.Robot-assisted laparoscopic repair of renal artery aneurysms..J Vasc Surg2010;51:842-9

[9] Giulianotti PC,Coratti A,Lombardi A.Robot-assisted treatment of splenic artery aneurysms..Ann Vasc Surg2011;25:377-83

[10] Abaza R,Castle E,Hu JC.Multi-institutional experience with robotic nephrectomy with inferior vena cava tumor thrombectomy..J Urol2016;195:865-71

[11] Boggi U,Costa F,Menonna F.Robotic-assisted pancreatic resections..World J Surg2016;40:2497-506

[12] Beane JD,Hamad A,Zeh HJ.Robotic pancreatoduodenectomy with vascular resection: outcomes and learning curve..Surgery2019;166:8-14

[13] Cai Y,Li Y,Peng B.Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach..Surg Endosc2018;32:4209-15

[14] Croome KP,Que FG,Truty MJ.Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches..J Gastrointest Surg2015;19:189-94discussion 194

[15] Dokmak S,Calmels M,Ftériche FS.Laparoscopic pancreaticoduodenectomy with reconstruction of the mesentericoportal vein with the parietal peritoneum and the falciform ligament..Surg Endosc2018;32:3256-61

[16] Giulianotti PC,Buchs NC,Bianco FM.Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors..Pancreas2011;40:1264-70

[17] Kendrick ML.Major venous resection during total laparoscopic pancreaticoduodenectomy..HPB (Oxford)2011;13:454-8 PMCID:PMC3133711

[18] Khatkov IE,Khisamov AA,Fingerhut A.Superior mesenteric-portal vein resection during laparoscopic pancreatoduodenectomy..Surg Endosc2017;31:1488-95

[19] Rosso E,Iannelli A.The ‘TRIANGLE Operation’ by laparoscopy: radical pancreaticoduodenectomy with major vascular resection for borderline resectable pancreatic head cancer..Ann Surg Oncol2020;27:1613-4

[20] Farges O,Truant S,Pruvot FR.The theory and practice of pancreatic surgery in France..Ann Surg2017;266:797-804

[21] Nimptsch U,Weber GF,Grutzmann R.Nationwide in-hospital mortality following pancreatic surgery in Germany is higher than anticipated..Ann Surg2016;264:1082-90