401 consecutive minimally invasive distal pancreatectomies: lessons learned from 20 years of experience.
Distal pancreatectomy
Laparoscopic surgery
Learning curve
Pancreatic ductal adenocarcinoma
Robotic surgery
Trocar site recurrence
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
received:
21
09
2021
accepted:
31
12
2021
pubmed:
2
2
2022
medline:
27
8
2022
entrez:
1
2
2022
Statut:
ppublish
Résumé
This study aimed to discuss and report the trend, outcomes, and learning curve effect after minimally invasive distal pancreatectomy (MIDP) at two high-volume centres. Patients undergoing MIDP between January 1999 and December 2018 were retrospectively identified from prospectively maintained electronic databases. The entire cohort was divided into two groups constituting the "early" and "recent" phases. The learning curve effect was analyzed for laparoscopic (LDP) and robotic distal pancreatectomy (RDP). The follow-up was at least 2 years. The study population included 401 consecutive patients (LDP n = 300, RDP n = 101). Twelve surgeons performed MIDP during the study period. Although patients were more carefully selected in the early phase, in terms of median age (49 vs. 55 years, p = 0.026), ASA class higher than 2 (3% vs. 9%, p = 0.018), previous abdominal surgery (10% vs. 34%, p < 0.001), and pancreatic adenocarcinoma (PDAC) (7% vs. 15%, p = 0.017), the recent phase had similar perioperative outcomes. The increase of experience in LDP was inversely associated with the operative time (240 vs 210 min, p < 0.001), morbidity rate (56.5% vs. 40.1%, p = 0.005), intra-abdominal collection (28.3% vs. 17.3%, p = 0.023), and length of stay (8 vs. 7 days, p = 0.009). Median survival in the PDAC subgroup was 53 months. In the setting of high-volume centres, the surgical training of MIDP is associated with acceptable rates of morbidity. The learning curve can be largely achieved by several team members, improving outcomes over time. Whenever possible resection of PDAC guarantees adequate oncological results and survival.
Sections du résumé
BACKGROUND
This study aimed to discuss and report the trend, outcomes, and learning curve effect after minimally invasive distal pancreatectomy (MIDP) at two high-volume centres.
METHODS
Patients undergoing MIDP between January 1999 and December 2018 were retrospectively identified from prospectively maintained electronic databases. The entire cohort was divided into two groups constituting the "early" and "recent" phases. The learning curve effect was analyzed for laparoscopic (LDP) and robotic distal pancreatectomy (RDP). The follow-up was at least 2 years.
RESULTS
The study population included 401 consecutive patients (LDP n = 300, RDP n = 101). Twelve surgeons performed MIDP during the study period. Although patients were more carefully selected in the early phase, in terms of median age (49 vs. 55 years, p = 0.026), ASA class higher than 2 (3% vs. 9%, p = 0.018), previous abdominal surgery (10% vs. 34%, p < 0.001), and pancreatic adenocarcinoma (PDAC) (7% vs. 15%, p = 0.017), the recent phase had similar perioperative outcomes. The increase of experience in LDP was inversely associated with the operative time (240 vs 210 min, p < 0.001), morbidity rate (56.5% vs. 40.1%, p = 0.005), intra-abdominal collection (28.3% vs. 17.3%, p = 0.023), and length of stay (8 vs. 7 days, p = 0.009). Median survival in the PDAC subgroup was 53 months.
CONCLUSION
In the setting of high-volume centres, the surgical training of MIDP is associated with acceptable rates of morbidity. The learning curve can be largely achieved by several team members, improving outcomes over time. Whenever possible resection of PDAC guarantees adequate oncological results and survival.
Identifiants
pubmed: 35102430
doi: 10.1007/s00464-021-08997-8
pii: 10.1007/s00464-021-08997-8
pmc: PMC9402493
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7025-7037Informations de copyright
© 2022. The Author(s).
Références
Jin T, Altaf K, Xiong JJ, Huang W, Javed MA, Mai G, Liu XB, Hu WM, Xia Q (2012) A systematic review and meta-analysis of studies comparing laparoscopic and open distal pancreatectomy. HPB (Oxford) 14:711–724
doi: 10.1111/j.1477-2574.2012.00531.x
Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL (2012) Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 255:1048–1059
pubmed: 22511003
doi: 10.1097/SLA.0b013e318251ee09
Jusoh AC, Ammori BJ (2012) Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg Endosc 26:904–913
pubmed: 22083328
doi: 10.1007/s00464-011-2016-3
Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G, Kössler-Ebs J, Müller-Stich BP, Büchler MW, Hackert T, Diener MK (2015) A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery 157:45–55
pubmed: 25482464
doi: 10.1016/j.surg.2014.06.081
Nakamura M, Nakashima H (2013) Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci 20:421–428
pubmed: 23224732
doi: 10.1007/s00534-012-0578-7
Pericleous S, Middleton N, McKay SC, Bowers KA, Hutchins RR (2012) Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure? Pancreas 41:993–1000
pubmed: 22836858
doi: 10.1097/MPA.0b013e31824f3669
Sui CJ, Li B, Yang JM, Wang SJ, Zhou YM (2012) Laparoscopic versus open distal pancreatectomy: a meta-analysis. Asian J Surg 35:1–8
pubmed: 22726557
doi: 10.1016/j.asjsur.2012.04.001
Xie K, Zhu YP, Xu XW, Chen K, Yan JF, Mou YP (2012) Laparoscopic distal pancreatectomy is as safe and feasible as open procedure: a meta-analysis. World J Gastroenterol 18:1959–1967
pubmed: 22563178
pmcid: 3337573
doi: 10.3748/wjg.v18.i16.1959
de Rooij T, van Hilst J, van Santvoort H, Boerma D, van den Boezem P, Daams F, van Dam R, Dejong C, van Duyn E, Dijkgraaf M, van Eijck C, Festen S, Gerhards M, Groot Koerkamp B, de Hingh I, Kazemier G, Klaase J, de Kleine R, van Laarhoven C, Luyer M, Patijn G, Steenvoorde P, Suker M, Abu Hilal M, Busch O, Besselink M (2019) Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg 269:2–9
pubmed: 30080726
doi: 10.1097/SLA.0000000000002979
Björnsson B, Larsson AL, Hjalmarsson C, Gasslander T, Sandström P (2020) Comparison of the duration of hospital stay after laparoscopic or open distal pancreatectomy: randomized controlled trial. Br J Surg
Asbun HJ, Moekotte AL, Vissers FL, Kunzler F, Cipriani F, Alseidi A, D’Angelica MI, Balduzzi A, Bassi C, Björnsson B, Boggi U, Callery MP, Del Chiaro M, Coimbra FJ, Conrad C, Cook A, Coppola A, Dervenis C, Dokmak S, Edil BH, Edwin B, Giulianotti PC, Han HS, Hansen PD, van der Heijde N, van Hilst J, Hester CA, Hogg ME, Jarufe N, Jeyarajah DR, Keck T, Kim SC, Khatkov IE, Kokudo N, Kooby DA, Korrel M, de Leon FJ, Lluis N, Lof S, Machado MA, Demartines N, Martinie JB, Merchant NB, Molenaar IQ, Moravek C, Mou YP, Nakamura M, Nealon WH, Palanivelu C, Pessaux P, Pitt HA, Polanco PM, Primrose JN, Rawashdeh A, Sanford DE, Senthilnathan P, Shrikhande SV, Stauffer JA, Takaori K, Talamonti MS, Tang CN, Vollmer CM, Wakabayashi G, Walsh RM, Wang SE, Zinner MJ, Wolfgang CL, Zureikat AH, Zwart MJ, Conlon KC, Kendrick ML, Zeh HJ, Hilal MA, Besselink MG (2020) The Miami international evidence-based guidelines on minimally invasive pancreas resection. Ann Surg 271:1–14
pubmed: 31567509
doi: 10.1097/SLA.0000000000003590
Lof S, Moekotte AL, Al-Sarireh B, Ammori B, Aroori S, Durkin D, Fusai GK, French JJ, Gomez D, Marangoni G, Marudanayagam R, Soonawalla Z, Sutcliffe R, White SA, Abu Hilal M, (UK) MILaPSSG-UM-L (2019) Multicentre observational cohort study of implementation and outcomes of laparoscopic distal pancreatectomy. Br J Surg 106:1657–1665
pubmed: 31454072
doi: 10.1002/bjs.11292
Capretti G, Boggi U, Salvia R, Belli G, Coppola R, Falconi M, Valeri A, Zerbi A (2019) Application of minimally invasive pancreatic surgery: an Italian survey. Updates Surg 71:97–103
pubmed: 29770922
doi: 10.1007/s13304-018-0535-3
Vining CC, Hogg ME (2020) How to train and evaluate minimally invasive pancreas surgery. J Surg Oncol 122:41–48
pubmed: 32215926
doi: 10.1002/jso.25912
Mark Knab L, Zenati MS, Khodakov A, Rice M, Al-Abbas A, Bartlett DL, Zureikat AH, Zeh HJ, Hogg ME (2018) Evolution of a novel robotic training curriculum in a complex general surgical oncology fellowship. Ann Surg Oncol 25:3445–3452
pubmed: 30073601
doi: 10.1245/s10434-018-6686-0
Malleo G, Damoli I, Marchegiani G, Esposito A, Marchese T, Salvia R, Bassi C, Butturini G (2015) Laparoscopic distal pancreatectomy: analysis of trends in surgical techniques, patient selection, and outcomes. Surg Endosc 29:1952–1962
pubmed: 25303912
doi: 10.1007/s00464-014-3890-2
Kneuertz PJ, Patel SH, Chu CK, Fisher SB, Maithel SK, Sarmiento JM, Weber SM, Staley CA, Kooby DA (2012) Laparoscopic distal pancreatectomy: trends and lessons learned through an 11-year experience. J Am Coll Surg 215:167–176
pubmed: 22632910
doi: 10.1016/j.jamcollsurg.2012.03.023
Lee SY, Allen PJ, Sadot E, D’Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR, Kingham TP (2015) Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. J Am Coll Surg 220:18–27
pubmed: 25456783
doi: 10.1016/j.jamcollsurg.2014.10.004
Daouadi M, Zureikat AH, Zenati MS, Choudry H, Tsung A, Bartlett DL, Hughes SJ, Lee KK, Moser AJ, Zeh HJ (2013) Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg 257:128–132
pubmed: 22868357
doi: 10.1097/SLA.0b013e31825fff08
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative S (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457
doi: 10.1016/S0140-6736(07)61602-X
Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G, Group S (2019) STROCSS 2019 guideline: strengthening the reporting of cohort studies in surgery. Int J Surg 72:156–165
doi: 10.1016/j.ijsu.2019.11.002
Surci N, Ramera M, Borin A, Marchegiani G, Salvia R, Bassi C, Group S (2020) Implementation of a strategic preoperative surgical meeting to improve the level of care at a high-volume pancreatic center: a before-after analysis of 1000 consecutive cases. Updates Surg 72:155–161
doi: 10.1007/s13304-020-00707-8
Esposito A, Landoni L, Casetti L, Andrianello S, Butturini G, Salvia R, Bassi C (2018) Spleen-preserving distal pancreatectomy with and without preservation of the splenic vessels. In: Boggi U (ed) Minimally invasive surgery of the pancreas. Springer, Mailand, pp 179–185
Butturini G, Giardino A, Damoli I, Esposito A, Frigerio I, Ramera M (2018) Robotic distal pancreatectomy with En bloc splenectomy. In: Boggi U (ed) Minimally invasive surgery of the pancreas. Springer, Mailand, pp 211–217
Esposito A, Casetti L, De Pastena M, Ramera M, Montagnini G, Landoni L, Bassi C, Salvia R (2020) Robotic spleen-preserving distal pancreatectomy: the Verona experience. Updates Surg
Paiella S, De Pastena M, Korrel M, Pan TL, Butturini G, Nessi C, De Robertis R, Landoni L, Casetti L, Giardino A, Busch O, Pea A, Esposito A, Besselink M, Bassi C, Salvia R (2019) Long term outcome after minimally invasive and open Warshaw and Kimura techniques for spleen-preserving distal pancreatectomy: International multicenter retrospective study. Eur J Surg Oncol 45:1668–1673
pubmed: 31005470
doi: 10.1016/j.ejso.2019.04.004
Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, Talamini G, Pederzoli P (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252:207–214
pubmed: 20622661
doi: 10.1097/SLA.0b013e3181e61e88
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
pubmed: 15273542
pmcid: 1360123
doi: 10.1097/01.sla.0000133083.54934.ae
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic S (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591
pubmed: 28040257
doi: 10.1016/j.surg.2016.11.014
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25
pubmed: 17629996
doi: 10.1016/j.surg.2007.02.001
Besselink MG, van Rijssen LB, Bassi C, Dervenis C, Montorsi M, Adham M, Asbun HJ, Bockhorn M, Strobel O, Büchler MW, Busch OR, Charnley RM, Conlon KC, Fernández-Cruz L, Fingerhut A, Friess H, Izbicki JR, Lillemoe KD, Neoptolemos JP, Sarr MG, Shrikhande SV, Sitarz R, Vollmer CM, Yeo CJ, Hartwig W, Wolfgang CL, Gouma DJ, Surgery ISGoP (2017) Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery. Surgery 161:365–372
pubmed: 27692778
doi: 10.1016/j.surg.2016.06.058
Ricci C, Casadei R, Buscemi S, Taffurelli G, D’Ambra M, Pacilio CA, Minni F (2015) Laparoscopic distal pancreatectomy: what factors are related to the learning curve? Surg Today 45:50–56
pubmed: 24610347
doi: 10.1007/s00595-014-0872-x
Napoli N, Kauffmann EF, Perrone VG, Miccoli M, Brozzetti S, Boggi U (2015) The learning curve in robotic distal pancreatectomy. Updates Surg 67:257–264
pubmed: 25990666
doi: 10.1007/s13304-015-0299-y
Association AD (2020) 2. Classification and diagnosis of diabetes. Diabetes Care 43:S14-S31
de Rooij T, Cipriani F, Rawashdeh M, van Dieren S, Barbaro S, Abuawwad M, van Hilst J, Fontana M, Besselink MG, Abu Hilal M (2017) Single-surgeon learning curve in 111 laparoscopic distal pancreatectomies: does operative time tell the whole story? J Am Coll Surg 224:826-832.e821
pubmed: 28126547
doi: 10.1016/j.jamcollsurg.2017.01.023
Moekotte AL, Rawashdeh A, Asbun HJ, Coimbra FJ, Edil BH, Jarufe N, Jeyarajah DR, Kendrick ML, Pessaux P, Zeh HJ, Besselink MG, Abu Hilal M, Hogg ME, IE-BGoMIPR (IG-MIPR) (2020) Safe implementation of minimally invasive pancreas resection: a systematic review. HPB (Oxford) 22:637–648
doi: 10.1016/j.hpb.2019.11.005
Braga M, Ridolfi C, Balzano G, Castoldi R, Pecorelli N, Di Carlo V (2012) Learning curve for laparoscopic distal pancreatectomy in a high-volume hospital. Updates Surg 64:179–183
pubmed: 22763577
doi: 10.1007/s13304-012-0163-2
Barrie J, Ammori BJ (2015) Minimally invasive distal pancreatectomy: a single-center analysis of outcome with experience and systematic review of the literature. Surg Laparosc Endosc Percutan Tech 25:297–302
pubmed: 26147049
doi: 10.1097/SLE.0000000000000185
Dokmak S, Ftériche FS, Aussilhou B, Lévy P, Ruszniewski P, Cros J, Vullierme MP, Khoy Ear L, Belghiti J, Sauvanet A (2017) The largest European single-center experience: 300 laparoscopic pancreatic resections. J Am Coll Surg 225:226-234.e222
pubmed: 28414116
doi: 10.1016/j.jamcollsurg.2017.04.004
Sahakyan MA, Røsok BI, Tholfsen T, Kleive D, Waage A, Ignjatovic D, Buanes T, Labori KJ, Edwin B (2021) Implementation and training with laparoscopic distal pancreatectomy: 23-year experience from a high-volume center. Surg Endosc
Takahashi C, Shridhar R, Huston J, Meredith K (2018) Outcomes associated with robotic approach to pancreatic resections. J Gastrointest Oncol 9:936–941
pubmed: 30505596
pmcid: 6219977
doi: 10.21037/jgo.2018.08.04
Shyr BU, Chen SC, Shyr YM, Wang SE (2018) Learning curves for robotic pancreatic surgery-from distal pancreatectomy to pancreaticoduodenectomy. Medicine (Baltimore) 97:e13000
Shakir M, Boone BA, Polanco PM, Zenati MS, Hogg ME, Tsung A, Choudry HA, Moser AJ, Bartlett DL, Zeh HJ, Zureikat AH (2015) The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre. HPB (Oxford) 17:580–586
doi: 10.1111/hpb.12412
Nakata K, Shikata S, Ohtsuka T, Ukai T, Miyasaka Y, Mori Y, Velasquez VVDM, Gotoh Y, Ban D, Nakamura Y, Nagakawa Y, Tanabe M, Sahara Y, Takaori K, Honda G, Misawa T, Kawai M, Yamaue H, Morikawa T, Kuroki T, Mou Y, Lee WJ, Shrikhande SV, Tang CN, Conrad C, Han HS, Chinnusamy P, Asbun HJ, Kooby DA, Wakabayashi G, Takada T, Yamamoto M, Nakamura M (2018) Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis. J Hepatobiliary Pancreat Sci 25:476–488
pubmed: 29943909
doi: 10.1002/jhbp.569
Pendola F, Gadde R, Ripat C, Sharma R, Picado O, Lobo L, Sleeman D, Livingstone AS, Merchant N, Yakoub D (2017) Distal pancreatectomy for benign and low grade malignant tumors: short-term postoperative outcomes of spleen preservation—a systematic review and update meta-analysis. J Surg Oncol 115:137–143
pubmed: 28133818
doi: 10.1002/jso.24507
Milito P, Aiolfi A, Asti E, Rausa E, Bonitta G, Bonavina L (2019) Impact of spleen preserving laparoscopic distal pancreatectomy on postoperative infectious complications: systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A 29:167–177
pubmed: 30592691
doi: 10.1089/lap.2018.0738
Moekotte AL, Lof S, White SA, Marudanayagam R, Al-Sarireh B, Rahman S, Soonawalla Z, Deakin M, Aroori S, Ammori B, Gomez D, Marangoni G, Abu Hilal M, (UK) MIlaPSSG-UM-L (2020) Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study. Surg Endosc 34:1301–1309
pubmed: 31236723
doi: 10.1007/s00464-019-06901-z
Bonanni P, Grazzini M, Niccolai G, Paolini D, Varone O, Bartoloni A, Bartalesi F, Santini MG, Baretti S, Bonito C, Zini P, Mechi MT, Niccolini F, Magistri L, Pulci MB, Boccalini S, Bechini A (2017) Recommended vaccinations for asplenic and hyposplenic adult patients. Hum Vaccin Immunother 13:359–368
pubmed: 27929751
doi: 10.1080/21645515.2017.1264797
Di Sabatino A, Lenti MV, Tinozzi FP, Lanave M, Aquino I, Klersy C, Marone P, Marena C, Pietrabissa A, Corazza GR (2017) Vaccination coverage and mortality after splenectomy: results from an Italian single-centre study. Intern Emerg Med 12:1139–1147
pubmed: 28799083
doi: 10.1007/s11739-017-1730-9
Wang J, Jones P, Cheng AC, Leder K (2014) Adherence to infection prevention measures in a statewide spleen registry. Med J Aust 200:538–540
pubmed: 24835718
doi: 10.5694/mja13.10630
Casciani F, Trudeau MT, Vollmer CM, Jr (2020) Perioperative immunization for splenectomy and the surgeon’s responsibility: a review. JAMA Surg
Wu L, Nahm CB, Jamieson NB, Samra J, Clifton-Bligh R, Mittal A, Tsang V (2020) Risk factors for development of diabetes mellitus (Type 3c) after partial pancreatectomy: a systematic review. Clin Endocrinol (Oxf) 92:396–406
doi: 10.1111/cen.14168
De Bruijn KM, van Eijck CH (2015) New-onset diabetes after distal pancreatectomy: a systematic review. Ann Surg 261:854–861
pubmed: 24983994
doi: 10.1097/SLA.0000000000000819
Landoni L, De Pastena M, Fontana M, Malleo G, Esposito A, Casetti L, Marchegiani G, Tuveri M, Paiella S, Pea A, Ramera M, Borin A, Giardino A, Frigerio I, Girelli R, Bassi C, Butturini G, Salvia R (2021) A randomized controlled trial of stapled versus ultrasonic transection in distal pancreatectomy. Surg Endosc
Sulpice L, Farges O, Goutte N, Bendersky N, Dokmak S, Sauvanet A, Delpero JR, Group AFPS (2015) Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: time for a randomized controlled trial? Results of an all-inclusive national observational study. Ann Surg 262:868–873; discussion 873–864
Nassour I, Winters SB, Hoehn R, Tohme S, Adam MA, Bartlett DL, Lee KK, Paniccia A, Zureikat AH (2020) Long-term oncologic outcomes of robotic and open pancreatectomy in a national cohort of pancreatic adenocarcinoma. J Surg Oncol 122:234–242
pubmed: 32350882
doi: 10.1002/jso.25958
Gaszynski R, Gray A, Merrett N (2020) Port-site metastasis of pancreatic adenocarcinoma following “successful” completion of neoadjuvant chemoradiation using FOLFIRINOX. ANZ J Surg 90:922–924
pubmed: 31578779
doi: 10.1111/ans.15441
Koga C, Tanemura M, Wada H, Kobayashi S, Marubashi S, Eguchi H, Mori M, Doki Y, Nagano H (2011) A case report of port-site metastasis of pancreatic cancer after laparoscope assistted distal pancreatectomy. Gan To Kagaku Ryoho 38:2454–2456
pubmed: 22202411
Iuppa A, Petralia GA, Sciuto A, Romeo G (1996) Abdominal wall metastasis of pancreatic adenocarcinoma following laparoscopy. Ann Ital Chir 67:265–269; discussion 269–270
Berends FJ, Kazemier G, Bonjer HJ, Lange JF (1994) Subcutaneous metastases after laparoscopic colectomy. Lancet 344:58
pubmed: 7912321
doi: 10.1016/S0140-6736(94)91079-0
Emoto S, Ishigami H, Yamaguchi H, Ishihara S, Sunami E, Kitayama J, Watanabe T (2017) Port-site metastasis after laparoscopic surgery for gastrointestinal cancer. Surg Today 47:280–283
pubmed: 27226019
doi: 10.1007/s00595-016-1346-0