Ann Surg Treat Res.  2014 Dec;87(6):285-289. 10.4174/astr.2014.87.6.285.

Feasibility and outcomes of laparoscopic enucleation for pancreatic neoplasms

• Choi KS
• Chung JC
• Kim HC

• KMID: 2167083
• DOI: http://doi.org/10.4174/astr.2014.87.6.285

Abstract

PURPOSE
With the advancement of laparoscopic techniques and instruments, laparoscopic approach for pancreatic lesions has become an increasingly used procedure. But, there are few and limited studies about laparoscopic enuleation (LE) for pancreatic lesions. Therefore, the purpose of this study was to present our experience and to evaluate the clinical outcome of LE for pancreatic benign or borderline malignant tumors.
METHODS
Between May 2005 and December 2011, 11 patients who underwent LE were analyzed. Candidates for LE met the following criteria: benign or borderline malignant pancreatic tumor, no involvement of main pancreatic duct, and outwardly growing tumor with small tumor bed.
RESULTS
All 11 patients (10 women and 1 man with a mean age of 43.1 +/- 11.9 years) who underwent LE were completed laparoscopically without conversion. The mean diameter of tumor was 4.0 +/- 3.3 cm and all cases had benign tumors at the final pathologic diagnosis. One patient (9%) developed pancreatic fistula and mean postoperative hospital stay was 5.5 +/- 1.7 days. During follow-up period (mean, 44.3 +/- 23.9 months), all patients were alive with no recurrence or new onset of diabetes.
CONCLUSION
LE is a safe and effective procedure, and should be considered as a treatment option for pancreatic lesions that do not involve the main pancratic duct and have an outgrowing aspect with small tumor bed.

Keyword

Pancreatic neoplasm; Enucleation; Laparoscopic surgery; Laparoscopy

MeSH Terms

Diagnosis
Female
Follow-Up Studies
Humans
Laparoscopy
Length of Stay
Pancreatic Ducts
Pancreatic Fistula
Pancreatic Neoplasms*
Recurrence

Figure

• 

  Fig. 1 Trocar placement for laparoscopic enucleation.

Reference

1. Dedieu A, Rault A, Collet D, Masson B, Sa Cunha A. Laparoscopic enucleation of pancreatic neoplasm. Surg Endosc. 2011; 25:572–576.

2. Kahl S, Malfertheiner P. Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. Best Pract Res Clin Gastroenterol. 2004; 18:947–955.

3. Talamini MA, Moesinger R, Yeo CJ, Poulose B, Hruban RH, Cameron JL, et al. Cystadenomas of the pancreas: is enucleation an adequate operation? Ann Surg. 1998; 227:896–903.

4. Kiely JM, Nakeeb A, Komorowski RA, Wilson SD, Pitt HA. Cystic pancreatic neoplasms: enucleate or resect? J Gastrointest Surg. 2003; 7:890–897.

5. Crippa S, Bassi C, Salvia R, Falconi M, Butturini G, Pederzoli P. Enucleation of pancreatic neoplasms. Br J Surg. 2007; 94:1254–1259.

6. Ge C, Luo X, Chen X, Guo K. Enucleation of pancreatic cystadenomas. J Gastrointest Surg. 2010; 14:141–147.

7. Fernandez-Cruz L, Blanco L, Cosa R, Rendon H. Is laparoscopic resection adequate in patients with neuroendocrine pancreatic tumors? World J Surg. 2008; 32:904–917.

8. Singh N, Lo CY, Chan WF. Laparoscopic enucleation of a nonfunctioning neuroendocrine tumor at the head of the pancreas. JSLS. 2006; 10:259–262.

9. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138:8–13.

10. Iihara M, Kanbe M, Okamoto T, Ito Y, Obara T. Laparoscopic ultrasonography for resection of insulinomas. Surgery. 2001; 130:1086–1091.

11. Lo CY, Chan WF, Lo CM, Fan ST, Tam PK. Surgical treatment of pancreatic insulinomas in the era of laparoscopy. Surg Endosc. 2004; 18:297–302.

12. Sand JA, Hyoty MK, Mattila J, Dagorn JC, Nordback IH. Clinical assessment compared with cyst fluid analysis in the differential diagnosis of cystic lesions in the pancreas. Surgery. 1996; 119:275–280.

13. Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, et al. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery. 2005; 137:597–605.