gms | German Medical Science

129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

Minimal Invasive Pancreatic Resections for Malignant Tumors

Meeting Abstract

  • Ulrich Friedrich Wellner - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Olivia Sick - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Frank Makowiec - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Dirk Bausch - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Ullrich Theodor Hopt - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Tobias Keck - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch357

DOI: 10.3205/12dgch357, URN: urn:nbn:de:0183-12dgch3579

Veröffentlicht: 23. April 2012

© 2012 Wellner et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: There is a trend towards minimal invasive procedures in current surgery practice, but laparoscopic pancreatic resections are only rarely performed for malignant disease. The discussion is so far based on expert opinions. The aim of this study was to evaluate the perioperative and especially oncologic outcome after laparoscopic pancreatic resections for malignant tumors.

Materials and methods: From a prospectively maintained database, patients with minimal invasive pancreatic resections (MIN) were identified. Patients were grouped according to underlying disease in resections for malignancy (LAP-MAL) and other (LAP-OTH). Open conventional pancreatic resections for periampullary cancer (OPEN-MAL) served as a control group. Statistical analysis was performed with SPSS software version 17.0.

Results: In total 57 patients received minimal invasive pancreatic surgery, among them 25 pancreatic resections, of which nine were performed for pancreatic or ampullary cancer. While 8/9 of LAP-MAL were laparoscopic pancreatoduodenectomies, 10/15 of LAP-OTH were laparoscopic pancreatic left resections. The conversion rate to open surgery was 4/9 in LAP-MAL and 3/15 in LAP-OTH for reasons of portal venous tumor invasion (n=4), discovery of secondary malignancy (n=1), hemorrhage (n=1) and adhesions (1).

Incidence of surgery-related complications, pancreatic fistula (ISGPS Grade B/C), reoperation and median hospital stay in LAP-MAL vs OPEN-MAL were 11% vs 45% (p=0.08), 11% vs 17% (p>0.05), 11% vs 10% (p>0.05) and 13 vs 17 days (p<0.05), respectively. Mortality was zero for all MIN.

As for the oncologic results in LAP-MAL vs OPEN-MAL, median tumor size (29 vs 25mm), R0 resection rate (100% vs 75%), number of total lymph nodes (15 vs 16) and lymph node ratio (0.11 vs 0.10) were comparable (p>0.05).

Conclusion: Minimal invasive pancreatic resections for malignancy are feasible with sufficient radicality, portal venous invasion being the main reason for conversion to open surgery at a late stage of the procedure. Perioperative morbidity rates compare favorably to open procedures, making minimal invasive operations a valid alternative to open pancreatic surgery also for malignant tumors.