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J.Jpn. Surg. Soc.. 123(5): 409-415, 2022


Feature topic

CURRENT STATUS OF LAPAROSCOPIC DISTAL PANCREATECTOMY

Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan

Daisuke Ban, Satoshi Nara, Takeshi Takamoto, Takahiro Mizui, Minoru Esaki, Kazuaki Shimada

Laparoscopic distal pancreatectomy (LDP) has been performed not only for benign and borderline malignant lesions but also for pancreatic cancer. The PAM-HBP Surgery Project was launched in Japan in 2021 to promote safe, minimally invasive pancreatectomy. The consensus conference focused on the detailed anatomy revealed by the magnification effect and the approach to minimally invasive pancreatectomy, and shared knowledge on how to safely perform minimally invasive pancreatectomies. Large retrospective observational studies have shown that LDP is superior to open surgery in terms of less blood loss and earlier recovery, with comparable complication and mortality rates. The R0 resection rate and lymph node dissection for pancreatic cancer were reported to be equivalent to those of open surgery, and the prognosis was also equivalent to that of open surgery. Recently, the National Cancer Database in the USA reported that minimally invasive distal pancreatectomy including LDP and robotic surgery showed better survival rates by matching patient background and tumor factors with propensity scores, but this may include potential selection bias. Careful evaluation is warranted based on the results of future randomized controlled trials.


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