No survival data were provided.

Based on these data, LDP appeared to be an appropriate oncologic surgical approach in select patients with cancer of the body/tail of pancreas. Laparoscopic pancreaticoduodenectomy (LPD) was first described by Gagner and Pomp in 1994 (60). Due to the complexity of the operation and lack of apparent advantages, reports regarding LPD contained case Inhibitors,research,lifescience,medical reports and small series. Series containing 10 or more successful LPD are listed in Table 1. While these reports demonstrated the safety and feasibility of performing LPD, larger prospective trials are needed to further define the advantage, if any, of LPD. Table 1 Select Literature on Laparoscopic PD Role of extended retroperitoneal lymphadenectomy Nodal status is a significant prognostic variable in pancreatic cancer. The number of nodes involved with metastases, the ratio of lymph node involvement, and the minimum number of lymph nodes examined had all been shown to have prognostic significance (67)-(69). Because of the importance of nodal staging, extended Inhibitors,research,lifescience,medical lymphadenectomy (EL) during pancreaticoduodenectomy was proposed to improve the surgical outcome of pancreatic cancer patients. The definition of EL is not uniform. Commonly EL referred to the dissection of additional

Inhibitors,research,lifescience,medical lymph nodes along the aorta from the diaphragmatic hiatus to the inferior mesenteric artery and laterally to the renal hila with circumferential clearance of the celiac trunk (70). While several groups from Japan

had reported favorable outcome following EL during pancreaticoduodenectomy (71)-(73), multiple randomized trials had not demonstrated an improvement in overall survival following EL (70),(74)-(76). Yeo et al also observed a significantly Inhibitors,research,lifescience,medical higher complication rate associated with the radical surgery group (43%) compared with the standard pancreaticoduodenectomy group Inhibitors,research,lifescience,medical (29%) (74). Higher rates of delayed gastric emptying and pancreatic fistula and longer hospital stay were observed in the radical surgery group. The higher selleck products morbidity associated with EL was also reported in a meta-analysis on standard versus radical pancreaticoduodenectomy Batimastat (77). The authors also did not find a difference in survival between the standard versus radical pancreaticoduodenectomy. Portal vein and superior mesenteric vein resection Because achieving an R0 resection had prognostic significance for patient outcome, vascular resection during PD had been evaluated. The great majority of vascular resection during PD involved portal vein and superior mesenteric vein resection and reconstruction. Yekebes et al reported equivalent perioperative morbidity and mortality between the standard PD group and the group with vascular resection (78). The median survival was 15 months in patients with histopathologic proven vascular invasion and 16 months in those without (P=0.86).