Minimally Invasive Approach Of Pancreaticoduodenectomy by Laparoscopy

Abstract

Pancreatic cancer is rarely diagnosed at an early stage; two-thirds of patients have locally advanced or metastatic disease at the time of diagnosis. At the present time, accurate staging represents, without a doubt, one of the primary objectives to be pursued in the treatment of this disease. The choice of the best therapeutic strategy is, in fact, strictly dependent upon accurate preoperative staging and evaluation of respectability. A complete clinical evaluation should be performed, with a focus on performance status and optimization of comorbidities. Standard relevant laboratory blood work included serum tumor markers, Preoperative computerized tomography (CT) scans with pancreas protocol also should be performed. Magnetic resonance imaging and/or endoscopic ultrasonography should be selectively performed at the discretion of the surgeon. Appropriate patient selection is important and appropriate by the surgeon. Inclusion criteria included tumors confined to the pancreatic head or periampullary region and favorable vascular anatomy, as demonstrated on preoperative imaging. Exclusion criteria included multiple prior abdominal surgeries, anticipated hostile abdomen, locally advanced tumors, and inability to withstand prolonged anesthesia. Obese patients also (body mass index >40) are not good candidates for LPD. Presence of excessive adipose tissue in the greater and lesser omenta and retroperitoneal tissues does not augur well for laparoscopic completion of the procedure.