ReviewPancreatic resection in the era of laparoscopy: State of Art. A systematic review

- Laparoscopic pancreatectomy is not workable in all patients.
- Except for distal pancreatectomy, there is no clear trend towards laparoscopic approach.
- Comparative trials and standardization of laparoscopic procedures should be completed.

BackgroundInnovation in surgical devices and improvement in laparoscopic skills have gradually led to achieve more challenging surgical procedures. Among these demanding interventions is the pancreatic surgery that is seen as intraoperatively risky and with high postoperative morbi-mortality rate. In order to understand the complexity of laparoscopic pancreatic surgery, we performed a systematic review of literature.Data sourceA systematic review of literature was performed regarding laparoscopic pancreatic resection.ResultsLaparoscopic approach in pancreas resections has been extensively reported as safe and feasible regarding pancreaticoduodenectomy, distal pancreatectomy and pancreatic enucleation. Compared to open approach, no benefit in morbi-mortality has been demonstrated (except for laparoscopic distal pancreatectomy) and no controlled randomized trials have been reported.ConclusionsLaparoscopic approach is not workable in all patients and patient selection is not standardized. Additionally, most optimistic reports considering laparoscopic approach are produced by tertiary centres. Currently, two tasks should be accomplished 1°) standardization of the laparoscopic pancreatic procedures 2°) comparative trials to assess endpoint benefits of laparoscopic pancreatic resection compared with open procedures.