TY - JOUR
T1 - The hand-assisted laparoscopic approach to resection of pancreatic mucinous cystic neoplasms
T2 - An underused technique?
AU - Postlewait, Lauren M.
AU - Ethun, Cecilia G.
AU - McInnis, Mia R.
AU - Merchant, Nipun
AU - Parikh, Alexander
AU - Idrees, Kamran
AU - Isom, Chelsea A.
AU - Hawkins, William
AU - Fields, Ryan C.
AU - Strand, Matthew
AU - Weber, Sharon M.
AU - Cho, Clifford S.
AU - Salem, Ahmed
AU - Martin, Robert C.G.
AU - Scoggins, Charles
AU - Bentrem, David
AU - Kim, Hong J.
AU - Carr, Jacquelyn
AU - Ahmad, Syed
AU - Abbott, Daniel
AU - Wilson, Gregory C.
AU - Kooby, David A.
AU - Maithel, Shishir K.
N1 - Funding Information:
Presented at the 2016 International Hepato-Pancreato-Biliary Association (IHPBA) biannual meeting, April 20–23, Sao Paulo, Brazil. Address correspondence and reprint requests to Shishir K. Maithel, M.D., Winship Cancer Institute, Division of Surgical Oncology, 1365C Clifton Road NE, 2nd Floor, Atlanta, GA 30322, Office: 404-778-5777, Fax: 404-778-4255, E-mail: [email protected]. This study was supported in part by the Katz Foundation
PY - 2018/1
Y1 - 2018/1
N2 - Pancreatic mucinous cystic neoplasms (MCNs) are rare tumors typically of the distal pancreas that harbor malignant potential. Although resection is recommended, data are limited on optimal operative approaches to distal pancreatectomy for MCN. MCN resections (2000–2014; eight institutions) were included. Outcomes of minimally invasive and open MCN resections were compared. A total of 289 patients underwent distal pancreatectomy for MCN: 136(47%) minimally invasive and 153(53%) open. Minimally invasive procedures were associated with smaller MCN size (3.9 vs 6.8 cm; P 5 0.001), lower operative blood loss (192 vs 392 mL; P 5 0.001), and shorter hospital stay(5 vs 7 days; P 5 0.001) compared with open. Despite higher American Society of Anesthesiologists class, hand-assisted (n 5 46) had similar advantages as laparoscopic/robotic (n 5 76). When comparing hand-assisted to open, although MCN size was slightly smaller (4.1 vs 6.8 cm; P 5 0.001), specimen length, operative time, and nodal yield were identical. Similar to laparoscopic/robotic, hand-assisted had lower operative blood loss (161 vs 392 mL; P 5 0.001) and shorter hospital stay (5 vs 7 days; P 5 0.03) compared with open, without increased complications. Hand-assisted laparoscopic technique is a useful approach for MCN resection because specimen length, lymph node yield, operative time, and complication profiles are similar to open procedures, but it still offers the advantages of a minimally invasive approach. Hand-assisted laparoscopy should be considered as an alternative to open technique or as a successive step before converting from total laparoscopic to open distal pancreatectomy for MCN.
AB - Pancreatic mucinous cystic neoplasms (MCNs) are rare tumors typically of the distal pancreas that harbor malignant potential. Although resection is recommended, data are limited on optimal operative approaches to distal pancreatectomy for MCN. MCN resections (2000–2014; eight institutions) were included. Outcomes of minimally invasive and open MCN resections were compared. A total of 289 patients underwent distal pancreatectomy for MCN: 136(47%) minimally invasive and 153(53%) open. Minimally invasive procedures were associated with smaller MCN size (3.9 vs 6.8 cm; P 5 0.001), lower operative blood loss (192 vs 392 mL; P 5 0.001), and shorter hospital stay(5 vs 7 days; P 5 0.001) compared with open. Despite higher American Society of Anesthesiologists class, hand-assisted (n 5 46) had similar advantages as laparoscopic/robotic (n 5 76). When comparing hand-assisted to open, although MCN size was slightly smaller (4.1 vs 6.8 cm; P 5 0.001), specimen length, operative time, and nodal yield were identical. Similar to laparoscopic/robotic, hand-assisted had lower operative blood loss (161 vs 392 mL; P 5 0.001) and shorter hospital stay (5 vs 7 days; P 5 0.03) compared with open, without increased complications. Hand-assisted laparoscopic technique is a useful approach for MCN resection because specimen length, lymph node yield, operative time, and complication profiles are similar to open procedures, but it still offers the advantages of a minimally invasive approach. Hand-assisted laparoscopy should be considered as an alternative to open technique or as a successive step before converting from total laparoscopic to open distal pancreatectomy for MCN.
UR - http://www.scopus.com/inward/record.url?scp=85041963991&partnerID=8YFLogxK
M3 - Article
C2 - 29428029
AN - SCOPUS:85041963991
SN - 0003-1348
VL - 84
SP - 56
EP - 62
JO - American Surgeon
JF - American Surgeon
IS - 1
ER -