Laparoscopic Pancreatectomy for Pancreatic Lesions
Laparoscopic Pancreatectomy for Pancreatic Lesions
What is the current consensus regarding the use of laparoscopic pancreatectomy for potentially malignant pancreatic lesions (eg, large cystic adenomas of the pancreas)?
Laparoscopic resection of the pancreatic tail (and sometimes body) is a fairly recent innovation that is generally reserved for pseudocysts and for presumed benign cystic lesions. It is a technically demanding procedure that is rendered difficult or impossible by the presence of dense adhesions from previous pancreatic surgery or inflammation. Patients undergoing planned laparoscopic pancreatic surgery are told that their surgery may be converted to an "open" procedure for this reason. Some surgeons will convert to "open" procedure if splenectomy is required to remove a distal pancreatic mass or cyst. Mucinous cystic lesions may be identified prior to surgery by analysis of their contents, which can be sampled during endoscopic ultrasound by fine-needle aspiration. The fluid may stain positive for mucin, and approximately 50% of mucinous cystic lesions have elevated fluid levels of carcinoembryonic antigen. Mucinous cystic lesions should be removed because they have malignancy potential (unlike serous cystic [microcystic] lesions). The role of laparoscopic surgery for intraductal pancreatic mucin-secretin tumors has not been established.
The use of laparoscopic resection for small solid tumors of the pancreas (eg, islet cell tumors, carcinoids) has yet to be firmly established, but technically this approach is feasible. A histologically proven cystic adenocarcinoma of the pancreatic tail would not be appropriate for laparoscopic management due to the likelihood of at least local metastasis by the time it was discovered (these lesions usually are aggressive and carry a poor prognosis).
What is the current consensus regarding the use of laparoscopic pancreatectomy for potentially malignant pancreatic lesions (eg, large cystic adenomas of the pancreas)?
Laparoscopic resection of the pancreatic tail (and sometimes body) is a fairly recent innovation that is generally reserved for pseudocysts and for presumed benign cystic lesions. It is a technically demanding procedure that is rendered difficult or impossible by the presence of dense adhesions from previous pancreatic surgery or inflammation. Patients undergoing planned laparoscopic pancreatic surgery are told that their surgery may be converted to an "open" procedure for this reason. Some surgeons will convert to "open" procedure if splenectomy is required to remove a distal pancreatic mass or cyst. Mucinous cystic lesions may be identified prior to surgery by analysis of their contents, which can be sampled during endoscopic ultrasound by fine-needle aspiration. The fluid may stain positive for mucin, and approximately 50% of mucinous cystic lesions have elevated fluid levels of carcinoembryonic antigen. Mucinous cystic lesions should be removed because they have malignancy potential (unlike serous cystic [microcystic] lesions). The role of laparoscopic surgery for intraductal pancreatic mucin-secretin tumors has not been established.
The use of laparoscopic resection for small solid tumors of the pancreas (eg, islet cell tumors, carcinoids) has yet to be firmly established, but technically this approach is feasible. A histologically proven cystic adenocarcinoma of the pancreatic tail would not be appropriate for laparoscopic management due to the likelihood of at least local metastasis by the time it was discovered (these lesions usually are aggressive and carry a poor prognosis).
