Innovation of Diagnosis and Treatment for Pancreatic Cancer by Hiroki Yamaue

Author:Hiroki Yamaue
Language: eng
Format: epub
Publisher: Springer Singapore, Singapore

10.2.2 Patient Selection

Although the growing surgeon experience in LPD, patient selection is the first issue for LPD and most patients receiving LPD are well selected. There are a variety of diseases indicated for PD including periampullary tumor and chronic pancreatitis, but some patients should be excluded for LPD especially for the initial cases. The suitable cases are the patients with dilated common bile duct (CBD) and pancreatic duct. There are two critical procedures in LPD including uncinated process dissection and reconstruction of pancreatic stump. The conversion rate of LPD (around 10%) was higher than other laparoscopic abdominal surgery. The most common causes of conversion to open surgery were tumor involvement or uncontrollable bleeding during the mesenterico-portal vein dissection. Patients with small CBD, large tumor, prominent uncinate process, severe inflammation around mesenterico-portal vein, tumor invasion to major vessels, obesity, vascular anomaly, the elderly or other contraindication for minimal invasive surgery should be carefully selected in LPD. Obstructive jaundice is the common clinical manifestation in periampullary lesion and preoperative biliary drainage may increase the morbidity and mortality in patients receiving PD [10]. However, in patients with obstructive jaundice, preoperative jaundice relief is suggested before LDP because the pneumoperitoneum will increase the abdominal pressure which may cause ascending cholangitis in patients with bile stasis. In these two methods of biliary drainage (percutaneous external drainage or endoscopic internal drainage), external drainage is favored to avoid the inflammation effect of internal stent inserted in CBD. In non-drained obstructive jaundice preoperatively, the CBD was opened in the early stage of LPD to relieve the bile stasis and minimize the risk of ascending cholangitis.

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