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Is There a Role for Laparoscopic and/or Robotic Techniques for Borderline Resectable Tumors?

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Multimodality Management of Borderline Resectable Pancreatic Cancer

Abstract

Recent evidence suggests that minimally invasive approaches are safe and effective alternatives to open surgery in carefully selected patients with benign and malignant pancreatic disease. In this chapter, the role of laparoscopic and robotic approaches to resectable, borderline resectable, and locally advanced pancreatic ductal adenocarcinoma (PDA) is critically evaluated, focusing on metrics of safety, feasibility, and oncologic outcomes.

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References

  1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.

    Article  PubMed  Google Scholar 

  2. Kendrick ML. Laparoscopic and robotic resection for pancreatic cancer. Cancer J. 2012;18(6):571–6.

    Article  PubMed  Google Scholar 

  3. Winter JM, Brennan MF, Tang LH, D’Angelica MI, Dematteo RP, Fong Y, Klimstra DS, Jarnagin WR, Allen PJ. Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann Surg Oncol. 2012;19(1):169–75.

    Article  PubMed  Google Scholar 

  4. Tempero MA, Malafa MP, Behrman SW, Benson III AB, Casper ES, Chiorean EG, Chung V, et al. Pancreatic adenocarcinoma, version 2.2014: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2014;12(8):1083–93.

    PubMed  CAS  Google Scholar 

  5. Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, Lee JE, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13(8):1035–46.

    Article  PubMed  Google Scholar 

  6. Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, Linehan DC. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009;16(7):1727–33.

    Article  PubMed  Google Scholar 

  7. Yekebas EF, Bogoevski D, Cataldegirmen G, Kunze C, Marx A, Vashist YK, Schurr PG, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg. 2008;247(2):300–9.

    Article  PubMed  Google Scholar 

  8. Gagandeep S, Artinyan A, Jabbour N, Mateo R, Matsuoka L, Sher L, Genyk Y, Selby R. Extended pancreatectomy with resection of the celiac axis: the modified Appleby operation. Am J Surg. 2006;192(3):330–5.

    Article  PubMed  Google Scholar 

  9. Kondo S, Katoh H, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T. Results of radical distal pancreatectomy with en bloc resection of the celiac artery for locally advanced cancer of the pancreatic body. Langenbeck Arch Surg. 2003;388(2):101–6.

    Article  Google Scholar 

  10. Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PW, Vauthey JN, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26(21):3496–502.

    Article  PubMed  CAS  Google Scholar 

  11. Varadhachary GR, Wolff RA, Crane CH, Sun CC, Lee JE, Pisters PW, Vauthey JN, et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26(21):3487–95.

    Article  PubMed  CAS  Google Scholar 

  12. Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, Vauthey JN, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg. 2008;206(5):833–46. discussion 846–8.

    Article  PubMed  Google Scholar 

  13. Ferrone CR, Marchegiani G, Hong TS, Ryan DP, Deshpande V, McDonnell EI, Sabbatino F, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg. 2015;261(1):12–7.

    Article  PubMed  Google Scholar 

  14. Blazer M, Wu C, Goldberg RM, Phillips G, Schmidt C, Muscarella P, Wuthrick E, Williams TM, et al. Neoadjuvant Modified (m) FOLFIRINOX for Locally Advanced Unresectable (LAPC) and Borderline Resectable (BRPC) Adenocarcinoma of the Pancreas. Ann Surg Oncol. 2014. doi:10.1245/s10434-014-4225-1.

    PubMed Central  Google Scholar 

  15. Gillen S, Schuster T, Meyer Zum Buschenfelde C, Friess H, Kleeff J. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7(4), e1000267. doi:10.1371/journal.pmed.1000267.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  16. Clinical Outcomes of Surgical Therapy Study, Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350(20):2050–9.

    Article  Google Scholar 

  17. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25(21):3061–8.

    Article  PubMed  Google Scholar 

  18. DiNorcia J, Schrope BA, Lee MK, Reavey PL, Rosen SJ, Lee JA, Chabot JA, Allendorf JD. Laparoscopic distal pancreatectomy offers shorter hospital stays with fewer complications. J Gastrointest Surg. 2010;14(11):1804–12.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Fernandez-Cruz L, Cosa R, Blanco L, Levi S, Lopez-Boado MA, Navarro S. Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg. 2007;11(12):1607–21. discussion 1621–2.

    Article  PubMed  Google Scholar 

  20. Jayaraman S, Gonen M, Brennan MF, D'Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR, Allen PJ. Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. J Am Coll Surg. 2010;211(4):503–9.

    Article  PubMed  Google Scholar 

  21. Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW, Lee SK, Kim MH, Han DJ. Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc. 2008;22(10):2261–8.

    Article  PubMed  Google Scholar 

  22. Kneuertz PJ, Patel SH, Chu CK, Fisher SB, Maithel SK, Sarmiento JM, Weber SM, et al. Laparoscopic distal pancreatectomy: trends and lessons learned through an 11-year experience. J Am Coll Surg. 2012;215(2):167–76.

    Article  PubMed  Google Scholar 

  23. Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, et al. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery. 2005;137(6):597–605.

    Article  PubMed  Google Scholar 

  24. Rosok BI, Marangos IP, Kazaryan AM, Rosseland AR, Buanes T, Mathisen O, Edwin B. Single-centre experience of laparoscopic pancreatic surgery. Br J Surg. 2010;97(6):902–9.

    Article  PubMed  CAS  Google Scholar 

  25. Song KB, Kim SC, Park JB, Kim YH, Jung YS, Kim MH, Lee SK, et al. Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection. Surg Endosc. 2011;25(10):3364–72.

    Article  PubMed  Google Scholar 

  26. Vijan SS, Ahmed KA, Harmsen WS, Que FG, Reid-Lombardo KM, Nagorney DM, Donohue JH, Farnell MB, Kendrick ML. Laparoscopic vs open distal pancreatectomy: a single-institution comparative study. Arch Surg. 2010;145(7):616–21.

    Article  PubMed  Google Scholar 

  27. Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, et al. Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg. 2008;248(3):438–46.

    PubMed  Google Scholar 

  28. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, International Study Group on Pancreatic Fistula, D, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.

    Article  PubMed  Google Scholar 

  29. Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, et al. A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg. 2010;210(5):779–85. 786–7.

    Article  PubMed  Google Scholar 

  30. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8(5):408–10.

    Article  PubMed  CAS  Google Scholar 

  31. Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc. 2006;20(7):1045–50.

    Article  PubMed  CAS  Google Scholar 

  32. Gagner M, Pomp A. Laparoscopic pancreatic resection: is it worthwhile? J Gastrointest Surg. 1997;1(1):20–5. discussion 25–6.

    Article  PubMed  CAS  Google Scholar 

  33. Palanivelu C, Rajan PS, Rangarajan M, Vaithiswaran V, Senthilnathan P, Parthasarathi R, Praveen Raj P. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg. 2009;16(6):731–40.

    Article  PubMed  CAS  Google Scholar 

  34. Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg. 2010;145(1):19–23.

    Article  PubMed  Google Scholar 

  35. Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg. 2014;260(4):633–8. discussion 638–40.

    Article  PubMed  Google Scholar 

  36. Wu W, He J, Cameron JL, Makary M, Soares K, Ahuja N, Rezaee N, et al. The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma. Ann Surg Oncol. 2014;21(9):2873–81.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y, Adenis A, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364(19):1817–25.

    Article  PubMed  CAS  Google Scholar 

  38. Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, Seay T, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369(18):1691–703.

    Article  CAS  Google Scholar 

  39. Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg. 2012;215(6):810–9.

    Article  PubMed  Google Scholar 

  40. Kuroki T, Adachi T, Okamoto T, Kanematsu T. A non-randomized comparative study of laparoscopy-assisted pancreaticoduodenectomy and open pancreaticoduodenectomy. Hepatogastroenterology. 2012;59(114):570–3.

    Article  PubMed  Google Scholar 

  41. Amodeo A, Linares Quevedo A, Joseph JV, Belgrano E, Patel HR. Robotic laparoscopic surgery: cost and training. Minerva Urol Nefrol. 2009;61(2):121–8.

    PubMed  CAS  Google Scholar 

  42. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G. Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003;138(7):777–84.

    Article  PubMed  Google Scholar 

  43. Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh III HJ. 250 robotic pancreatic resections: safety and feasibility. Ann Surg. 2013;258(4):554–9. discussion 559–62.

    PubMed Central  PubMed  Google Scholar 

  44. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10(9):1199–210. discussion 1210–1.

    Article  PubMed  Google Scholar 

  45. Magge D, Gooding W, Choudry H, Steve J, Steel J, Zureikat A, Krasinskas A, et al. Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma. JAMA Surg. 2013;148(6):525–31.

    Article  PubMed  Google Scholar 

  46. Daouadi M, Zureikat AH, Zenati MS, Choudry H, Tsung A, Bartlett DL, Hughes SJ, et al. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg. 2013;257(1):128–32.

    Article  PubMed  Google Scholar 

  47. Boggi U, Signori S, De Lio N, Perrone VG, Vistoli F, Belluomini M, Cappelli C, et al. Feasibility of robotic pancreaticoduodenectomy. Br J Surg. 2013;100(7):917–25.

    Article  PubMed  CAS  Google Scholar 

  48. Croome KP, Farnell MB, Que FG, Reid-Lombardo K, Truty MJ, Nagorney DM, Kendrick ML. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg. 2015;19(1):189–94.

    Article  PubMed  Google Scholar 

  49. Kendrick ML, Sclabas GM. Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB. 2011;13(7):454–8.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Giulianotti PC, Addeo P, Buchs NC, Ayloo SM, Bianco FM. Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors. Pancreas. 2011;40(8):1264–70.

    Article  PubMed  Google Scholar 

  51. Muller SA, Hartel M, Mehrabi A, Welsch T, Martin DJ, Hinz U, Schmied BM, Buchler MW. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg. 2009;13(4):784–92.

    Article  PubMed  Google Scholar 

  52. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Bao P, Potter D, Eisenberg DP, Lenzner D, Zeh HJ, Lee Iii KK, Hughes SJ, et al. Validation of a prediction rule to maximize curative (R0) resection of early-stage pancreatic adenocarcinoma. HPB. 2009;11(7):606–11.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Zureikat AH, Nguyen KT, Bartlett DL, Zeh HJ, Moser AJ. Robotic-assisted major pancreatic resection and reconstruction. Arch Surg. 2011;146(3):256–61.

    Article  PubMed  Google Scholar 

  55. Nguyen KT, Zureikat AH, Chalikonda S, Bartlett DL, Moser AJ, Zeh HJ. Technical aspects of robotic-assisted pancreaticoduodenectomy (RAPD). J Gastrointest Surg. 2011;15(5):870–5.

    Article  PubMed  Google Scholar 

  56. Zeh III HJ, Bartlett DL, Moser AJ. Robotic-assisted major pancreatic resection. Adv Surg. 2011;45:323–40.

    Article  PubMed  Google Scholar 

  57. Pessaux P, Varma D, Arnaud JP. Pancreaticoduodenectomy: superior mesenteric artery first approach. J Gastrointest Surg. 2006;10(4):607–11.

    Article  PubMed  Google Scholar 

  58. Buchs NC, Addeo P, Bianco FM, Ayloo S, Benedetti E, Giulianotti PC. Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg. 2011;35(12):2739–46.

    Article  PubMed  Google Scholar 

  59. Lai EC, Yang GP, Tang CN. Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy—a comparative study. Int J Surg. 2012;10(9):475–9.

    Article  PubMed  Google Scholar 

  60. Chalikonda S, Aguilar-Saavedra JR, Walsh RM. Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc. 2012;26(9):2397–402.

    Article  PubMed  CAS  Google Scholar 

  61. Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P, Caravaglios G, Coratti A. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc. 2010;24(7):1646–57.

    Article  PubMed  Google Scholar 

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Correspondence to Amer H. Zureikat M.D., F.A.C.S. .

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Ocuin, L.M., Zeh, H.J., Zureikat, A.H. (2016). Is There a Role for Laparoscopic and/or Robotic Techniques for Borderline Resectable Tumors?. In: Katz, M., Ahmad, S. (eds) Multimodality Management of Borderline Resectable Pancreatic Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-22780-1_12

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  • DOI: https://doi.org/10.1007/978-3-319-22780-1_12

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