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Page 2 of 5 Addeo Mini-invasive Surg 2020;4:64 I http://dx.doi.org/10.20517/2574-1225.2020.47

Keywords: Pancreatectomy, vascular resection, venous resection, arterial resection, locally advanced tumours

INTRODUCTION
Since the first description in 1994 by Gagner and Pomp, minimally invasive (MIS) pancreaticoduodenectomy
[1]
(PD) has been considered among the most complex abdominal procedures . Even if the feasibility and
safety of the minimally invasive approach of MIS PD has been demonstrated in several randomized and
[2-5]
observational studies, reluctance still exist to embrace MIS for PD . PDs are in fact a complex procedure
entailing (1) extensive dissection around the mesenteric and coeliac vessels; (2) dissection above and
below the mesocolon (multi-quadrant procedure); (3) a long and a technically challenging digestive
reconstruction; and (4) inherent morbidity and mortality which seems not reduced by the MIS approach.

For these reasons, the MIS approach to PD is still not widely practised compared with other procedures
such as colonic and gastric resection. However, increased experience with laparoscopy and robotics in
surgery has allowed pioneer centres to test the feasibility and safety of these approaches for more advanced
procedures. In fact, from a theoretical point of view, the magnified view provided by the laparoscope and/
or the 3D vision achieved by robotics can be of great help during the dissection. This enhanced view,
coupled by the superior dexterity of the robotic instruments, can be of great help in complex suturing.

Indeed, complex procedures such as renal or splenic artery aneurysm repair, nephrectomy with caval
thrombectomy, and kidney and pancreas transplantation have been described in recent years [6-11] . As a
result of these developments and the increased experience achieved with MIS PDs, small series of MIS
pancreatectomies with vascular resection have been reported [3,5,11-19] . The safety and results of this approach
remains to be determined. In this article we systematically reviewed the literature on the topic of MIS PD
with vascular resection, evaluating the safety and feasibility as well as the outcomes of this approach.

METHODS
Data selection
The EMBASE, MEDLINE, and Cochrane central databases were systematically searched for articles
from January 1995 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, and it was limited to manuscripts written in English. The following were used as search terms:
“pancreaticoduodenectomy” combined with “laparoscopic” and/or “robotic” and “vascular resection”
and/or “venous resection”. Potentially eligible articles were screened, and exclusion criteria included: (1)
duplicated articles; (2) articles that were not in English or that described animal studies; and (3) registry
studies for whom the patient outcomes could not be precisely detailed. References of selected articles
were checked for additional cases. The primary outcomes of the review were feasibility of PD with venous
resection. Secondary outcomes were morbidity, mortality, blood loss and 1-year survival. All the data were
extracted using a standardized extraction form.

Statistical analysis
Continuous data are expressed as the mean ± standard deviation or the median and range as appropriate,
whereas categorical variables are presented as numbers and percentages. Differences between groups were
assessed by the chi-squared or Fisher’s exact test (categorical variables) and the Wilcoxon rank sum test or
the student’s t test (continuous variables).