Page 147 - Read Online
P. 147

Basso et al.                                                                                                                                                                            Mini-invasive distal pancreatectomy

           Our study has several limitations.  The main       F. Lumachi, A. Patanè, M. Ciocca Vasino, P. Ubiali
           one is that it utilized retrospective data, which
           may introduce selection bias and allow missing     Financial support and sponsorship
           information. Demographics, histology, and tumour   None.
           size were similar in both groups, despite the absence
           of randomization. However, the number of patients   Conflicts of interest
           in our series was low, but all available studies are   There are no conflicts of interest.
           similar  cohort-like  or  case-control  studies  from
           single centres, with few patients. Unfortunately, no   Patient consent
           long-term  data  are  available  in  our  series,  but  a   Informed consent was obtained from all patients.
           lack of long-term results and follow-up is common,
           as a result of the rarity of this type of disease and   Ethics approval
           heterogeneity of the studies. Particularly, long-  The  present study  is  a  retrospective review of
           term data on recurrence of pancreatic carcinomas   anonymized  clinical  records, and ethical permission
           are scarce, and larger comparative studies are     was obtained.
           needed. [20]
                                                              REFERENCES
           Rehman  et al.   found  no  significant  differences
                         [28]
           in 3-year OS between laparoscopic (n = 8) or open   1.   Tiwari MM, Reynoso JF, High R, Tsang AW, Oleynikov D. Safety,
                                                                 efficacy, and cost-effectiveness of common laparoscopic procedures.
           (n = 14) distal pancreatectomy for pancreatic         Surg Endosc 2011;25:1127-35.
           adenocarcinoma (82% vs. 74%). Similarly, Hu et al.    2.   Brokelman WJ, Lensvelt M, Borel Rinkes IH, Klinkenbijl JH, Reijnen
                                                         [50]
           compared 11 LDP and 23 ODP and found a mean OS        MM.  Peritoneal changes due to laparoscopic  surgery.  Surg Endosc
           42.0 ± 8.6 months vs. 54.0 ± 5.8 months. The Central   2011;25:1-9.
           Pancreas Consortium reported the same median OS    3.   Soper NJ, Brunt LM, Dunnegan DL, Meininger TA. Laparoscopic
           (16 months) after both procedures, in matched cohorts,   distal pancreatectomy in the porcine model.  Surg Endosc
                                                                 1994;8:57-60.
           suggesting that oncologic outcomes are similar and   4.   Cuschieri A. Laparoscopic  surgery  of the  pancreas.  J  R  Coll  Surg
           independent of the surgical approach. [6]             Edinb 1994;39:178-84.
                                                              5.   Takaori K, Tanigawa N. Laparoscopic pancreatic resection: the past,
           In  conclusion,  our  experience  confirms  that  the   present, and future. Surg Today 2007;37:535-45.
           minimally  invasive  surgical  treatment  of  tumours  of   6.   Kooby DA, Hawkins WG,  Schmidt  CM, Weber  SM, Bentrem  DJ,
           the distal pancreas is safe and feasible. Laparoscopic   Gillespie TW, Sellers  JB, Merchant  NB, Scoggins CR, Martin  RC
           pancreatectomy offers several advantages compared     3rd, Kim  HJ, Ahmad  S, Cho CS, Parikh AA, Chu CK, Hamilton
                                                                 NA,  Doyle CJ, Pinchot S, Hayman  A, McClaine R, Nakeeb  A,
           with  open  surgery,  including  a  significant  reduction   Staley CA, McMasters KM, Lillemoe KD. A multicenter analysis of
           of estimated blood loss, reduced postoperative pain   distal pancreatectomy for adenocarcinoma: is laparoscopic resection
           intensity, and earlier bowel canalization. However,   appropriate? J Am Coll Surg 2010;210:779-85.
           implementation of minimally invasive pancreatectomy   7.   Rutz DR, Squires MH, Maithel SK, Sarmiento JM, Etra JW, Perez
           requires  specific  skills  and  adequate  training,  both   SD, Knechtle W, Cardona K, Russell MC, Staley CA 3rd, Sweeney
           in  advanced laparoscopic  surgery and in  pancreatic   JF, Kooby DA. Cost comparison analysis of open versus laparoscopic
           surgery. Additional research and adequate RCTs are   8.   distal pancreatectomy. HPB 2014;16:907-14.
                                                                 ASA Physical  Status  Classification  System.  Last  approved  by  the
           needed before the technique can be considered the     ASA House of Delegates on October 15, 2014. Available at: https://
           “gold-standard” for distal pancreatectomies, to assess   www.asahq.org/resources/clinical-information/asa-physical-status-
           oncologic results and long-term outcomes. Finally, the   classification-system. [Last accessed on May 31, 2017]
           costs of laparoscopic surgery should be carefully re-  9.   Bassi  C,  Dervenis  C,  Butturini  G,  Fingerhut A,  Yeo  C,  Izbicki  J,
           evaluated before concluding that they are greater than   Neoptolemos J, Sarr M, Traverso W, Buchler M; International Study
           those of open surgery.                                Group  on  Pancreatic  Fistula  Definition.  Postoperative  pancreatic
                                                                 fistula:  an  international  study  group  (ISGPF)  definition.  Surgery
                                                                 2005;138:8-13.
           Authors’ contributions                             10.  Kehlet H, Wilmore DW. Multimodal strategies to improve surgical
           Designed the study: S.M.M. Basso, P. Ubiali           outcome. Am J Surg 2002;183:630-41.
           Acquired the data: F. Maffeis, A. Patanè           11.  Taylor C, O’Rourke N, Nathanson L, Martin I, Hopkins G, Layani
           Analyzed and interpreted the results: S.M.M. Basso, F.   L,  Ghusn M, Fielding  G. Laparoscopic  distal  pancreatectomy:  the
           Maffeis, F. Lumachi                                   Brisbane experience of forty-six cases. HPB (Oxford) 2008;10:38-42.
           Drafted the manuscript: S.M.M. Basso               12.  Tran  Cao  HS,  Lopez  N,  Chang  DC,  Lowy  AM,  Bouvet  M,
                                                                 Baumgartner JM, Talamini MA, Sicklick JK. Improved perioperative
           Revised the manuscript: S.M.M. Basso, F. Lumachi, M.   outcomes with minimally invasive distal pancreatectomy: results from
           Ciocca Vasino, P. Ubiali                              a population-based analysis. JAMA Surg 2014;149:237-43.
           Approved the final version: S.M.M. Basso, F. Maffeis,   13.  Joliat GR, Demartines N, Halkic N, Petermann D, Schafer M.
            140                                                                                                           Mini-invasive Surgery ¦ Volume 1 ¦ September 30
   142   143   144   145   146   147   148   149   150   151   152