Kooby David A
Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA.
Expert Rev Anticancer Ther. 2008 Oct;8(10):1597-609. doi: 10.1586/14737140.8.10.1597.
Laparoscopic (lap) organ resection is now commonly performed for the management of solid tumors of the kidney, colon, adrenal glands and prostate. Surgeons have been slower to adopt minimally invasive approaches to the pancreas owing to operative complexity and complication potential. The majority of existing reports concerning lap pancreatectomy are single-center studies that describe experience with fewer than 20 cases. Only recently have larger experiences surfaced demonstrating the safety and efficacy of lap tumor enucleation and lap left pancreatectomy. As neoplastic disease is the most common indication for pancreatic resection, understanding the effects of the lap approach to pancreatectomy on cancer outcome is crucial. In addition to concerns of port-site tumor recurrence and tumor dissemination due to lap manipulation in the setting of pneumoperitoneum, adequacy of resection as defined by margin status and nodal assessment must be considered. This review covers the development and current state-of-the-art of lap pancreatic surgery for cancer. Existing data are reviewed for both open and lap pancreatic resections, with particular attention to pancreatic ductal adenocarcinoma. Projections of future advances in the field of lap pancreatic surgery are provided.
腹腔镜（lap）器官切除术目前常用于治疗肾脏、结肠、肾上腺和前列腺的实体瘤。由于手术复杂性和潜在并发症，外科医生采用微创方法治疗胰腺疾病的速度较慢。现有的大多数关于腹腔镜胰腺切除术的报告都是单中心研究，描述的病例数少于20例。直到最近，才有更多的经验表明腹腔镜肿瘤剜除术和腹腔镜左半胰腺切除术的安全性和有效性。由于肿瘤性疾病是胰腺切除最常见的适应症，了解腹腔镜胰腺切除术对癌症预后的影响至关重要。除了担心气腹情况下腹腔镜操作导致的穿刺部位肿瘤复发和肿瘤播散外，还必须考虑切缘状态和淋巴结评估所定义的切除充分性。本综述涵盖了腹腔镜胰腺癌手术的发展和当前的技术水平。对开放和腹腔镜胰腺切除术的现有数据进行了综述，特别关注胰腺导管腺癌。还提供了腹腔镜胰腺手术领域未来进展的预测。
