Which Laparoscopic Treatment in Pancreatic Pathology?

Giorgio Maria Paolo Graziano, Antonio Di Cataldo, Antonino Graziano

Pancreatic cancer is in Italy the fourth place among the causes of death in women, which still maintains a poor prognosis with only 7% of men and 9% of women who have a 5-year survival. the highest incidence of the disease is between 6 and 7 decade of life. the aim of this study is to obtain treatment indications that are well codified with the possibility of extending their applications to perform both derivative and resective interventions .Materials and methods: From January 2010 to December 2017 at the department of specialized surgical science II of the AOU Policlinico di Catania were observed in 32 patients with pancreatic neoplasm of which women 22 and 10 men, with a mean age of 65 (58-72.a) The symptomatology was characterized by jaundice, weight loss, steatorrhea, onset of diabetes without an apparent reason, impaired intestinal motility (constipation and diarrhea), intolerance to fatty foods. 10% of the cases had a family history defined with at least 2 degree relatives affected by pancreatic neoplasm. the histological study obtained before the oncology therapy and with an endoscopic ultrasound method that was essential in defining the nature of non-neoplastic lesions, and we obtained a diagnosis of: ductal adenocarcinoma in 8 cases, of serous cystadenoma in 2 cases, cystic mucinous in 6 cases , intraductal in 3cases, acinar cells in 4 cases, similar papillary in 3cases, and neuroendocrine in 6 cases. Results : In the preoperative diagnosis the immunophenotypic profile was necessary to define the histological typology characterized by the ductal differentiation for the production of mucus. acinar differentiation for enzyme production, and neuroendocrine for chromogranin positivity. The tumor marker ca19.9 was positive in 100% of the cases observed with metastatic disease with a positive prognostic value of decrement in the postoperative period in those cases in which the resection of the tumor was carried out. Diagnostic-stapling laparoscopy was indispensable, at the time of diagnosis, were: 1) laparoscopy exploration revealed in 30% of cases the presence of metastases not shown with the usual procedures of preoperative staging. 2) The laparoscopic evaluation showed a positive predictive index of 100%, of the cases, and negative in 97% of the cases observed with a diagnostic accuracy of 97%. 3) Unsurpreted metastatic diffusion was more specifically reported in body-caudal tumors (30%) and cephalic lesions (20%). 4) Staging diagnostic laparoscopy Study the M parameter of tumor disease, with visualization of the surface of the abdominal cavity and of the liver, in order to exclude the presence of small, often multiple, peritoneal or sub-glissonian metastases which, if present , made the intervention useless.Discussion: Laparoscopic pancreatic surgery interventions, regardless of the tumor site and the type of intervention, even in the feasibility, are not yet fully accepted on the oncological level. This is due to both the reduced number of cases of resectable pancreatic carcinoma and the reduced number of laparoscopist surgeons dedicated to pancreatic surgery. (25,26,27,28) All this makes it more difficult to undertake multi-center studies that can demonstrate the oncological correctness of the method. The diagnosis then becomes mandatory in those cases in which the suspected tumor is high where the histological material is obtained before the intervention with a tissue sampling with trans cutaneous biopsy with multiple thin needle with a risk of low complications, in the presence of lesions resection. (29,30,31,32), Conclusions: From the results obtained, the indication emerges definitively to a standard diagnostic-stadiative laparoscopy, which allows to define with considerable accuracy the TNM action steps, with a modest impact on the time of use of the operating room. Laparoscopy in expert hands is a useful tool for pancreatic surgery not only for diagnosis but also for resective and palliative surgery.

https://doi.org/10.31871/IJNTR.4.6.10