Minimally invasive treatment of pancreatic cancer following neo<b>-</b>adjuvant chemotherapy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MENG Lingwei , WU Zhong ,  PENG Bing

Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

PENG Bing, Email: pengbing84@hotmail.com

Keywords：

pancreatic cancer; neo-adjuvant chemotherapy; minimally invasive surgery

DOI：

10.7507/1007-9424.202308003

Video：

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Radical surgical resection is still the only potentially curative treatment for pancreatic cancer. With the update of minimally invasive concepts, the laparoscopic and robotic platform has been introduced to pancreatic surgery practice. The recent studies have demonstrated that minimally invasive procedure achieved similar or improved perioperative outcomes compared to the standard open approach. Neo-adjuvant chemotherapy is increasingly being applied in pancreatic surgery, making surgical resection more challenging. Numbers of patients undergoing minimally invasive resection following neo-adjuvant chemotherapy remain low. The author consulted the latest literatures at home and abroad and described the current situation of minimally invasive treatment of pancreatic cancer after neo-adjuvant chemotherapy.

Citation： MENG Lingwei, WU Zhong, PENG Bing. Minimally invasive treatment of pancreatic cancer following neo-adjuvant chemotherapy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(9): 1025-1029. doi: 10.7507/1007-9424.202308003 Copy

1.	Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin, 2023, 73(1): 17-48.
2.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3.	Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med, 2018, 379(25): 2395-2406.
4.	Buanes TA. Role of surgery in pancreatic cancer. World J Gastroenterol, 2017, 23(21): 3765-3770.
5.	Truty MJ, Kendrick ML, Nagorney DM, et al. Factors predicting response, perioperative outcomes, and survival following total neoadjuvant therapy for borderline/locally advanced pancreatic cancer. Ann Surg, 2021, 273(2): 341-349.
6.	Cloyd JM, Heh V, Pawlik TM, et al. Neoadjuvant therapy for resectable and borderline resectable pancreatic cancer: a meta-analysis of randomized controlled trials. J Clin Med, 2020, 9(4): 1129.
7.	Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2021, 19(4): 439-457.
8.	中华人民共和国国家卫生健康委员会医政医管局. 胰腺癌诊疗指南(2022年版). 中华消化外科杂志, 2022, 21(9): 1117-1136.
9.	Wang M, Li D, Chen R, et al. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol, 2021, 6(6): 438-447.
10.	Qin R, Kendrick ML, Wolfgang CL, et al. International expert consensus on laparoscopic pancreaticoduodenectomy. Hepatobiliary Surg Nutr, 2020, 9(4): 464-483.
11.	Barreto SG, Loveday B, Windsor JA, et al. Detecting tumour response and predicting resectability after neoadjuvant therapy for borderline resectable and locally advanced pancreatic cancer. ANZ J Surg, 2019, 89(5): 481-487.
12.	李征, 虞先濬, 徐晓武. 胰腺癌新辅助化疗后行腹腔镜胰十二指肠切除术的难点及对策. 中国实用外科杂志, 2022, 42(5): 526-528.
13.	Elbanna KY, Jang HJ, Kim TK. Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review. Insights Imaging, 2020, 11(1): 58. .
14.	Kim R, Prithviraj G, Kothari N, et al. PET/CT fusion scan prevents futile laparotomy in early stage pancreatic cancer. Clin Nucl Med, 2015, 40(11): e501-e505.
15.	Ta R, O’Connor DB, Sulistijo A, et al. The role of staging laparoscopy in resectable and borderline resectable pancreatic cancer: A systematic review and meta-analysis. Dig Surg, 2019, 36(3): 251-260.
16.	Gudmundsdottir H, Yonkus JA, Alva-Ruiz R, et al. Yield of staging laparoscopy for pancreatic cancer in the modern era: analysis of more than 1 000 consecutive patients. J Am Coll Surg, 2023, 237(1): 49-57.
17.	Peng JS, Mino J, Monteiro R, et al. Diagnostic laparoscopy prior to neoadjuvant therapy in pancreatic cancer is high yield: an analysis of outcomes and costs. J Gastrointest Surg, 2017, 21(9): 1420-1427.
18.	Suker M, Koerkamp BG, Coene PP, et al. Yield of staging laparoscopy before treatment of locally advanced pancreatic cancer to detect occult metastases. Eur J Surg Oncol, 2019, 45(10): 1906-1911.
19.	Jayakrishnan TT, Nadeem H, Groeschl RT, et al. Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument. HPB (Oxford), 2015, 17(2): 131-139.
20.	徐强, 吴文铭, 韩显林, 等. 机器人胰体尾切除术学习曲线分析(附71例报告). 中国实用外科杂志, 2018, 38(7): 801-805, 810.
21.	Wang M, Meng L, Cai Y, et al. Learning curve for laparoscopic pancreaticoduodenectomy: a CUSUM analysis. J Gastrointest Surg, 2016, 20(5): 924-935.
22.	Wang X, Cai Y, Jiang J, et al. Laparoscopic pancreatico-duodenectomy: outcomes and experience of 550 patients in a single institution. Ann Surg Oncol, 2020, 27(11): 4562-4573.
23.	Wang M, Peng B, Liu J, et al. Practice patterns and perioperative outcomes of laparoscopic pancreaticoduodenectomy in China: A retrospective multicenter analysis of 1 029 patients. Ann Surg, 2021, 273(1): 145-153.
24.	Lof S, Korrel M, van Hilst J, et al. Impact of neoadjuvant therapy in resected pancreatic ductal adenocarcinoma of the pancreatic body or tail on surgical and oncological outcome: A propensity-score matched multicenter study. Ann Surg Oncol, 2020, 27(6): 1986-1996.
25.	Deiro G, De Pastena M, Paiella S, et al. Assessment of difficulty in laparoscopic distal pancreatectomy: A modification of the Japanese difficulty scoring system—A single-center high-volume experience. J Hepatobiliary Pancreat Sci, 2021, 28(9): 770-777.
26.	Torphy RJ, Friedman C, Halpern A, et al. Comparing short-term and oncologic outcomes of minimally invasive versus open pancreaticoduodenectomy across low and high volume centers. Ann Surg, 2019, 270(6): 1147-1155.
27.	Chapman BC, Gajdos C, Hosokawa P, et al. Comparison of laparoscopic to open pancreaticoduodenectomy in elderly patients with pancreatic adenocarcinoma. Surg Endosc, 2018, 32(5): 2239-2248.
28.	Kantor O, Talamonti MS, Sharpe S, et al. Laparoscopic pancreaticoduodenectomy for adenocarcinoma provides short-term oncologic outcomes and long-term overall survival rates similar to those for open pancreaticoduodenectomy. Am J Surg, 2017, 213(3): 512-515.
29.	Nussbaum DP, Adam MA, Youngwirth LM, et al. Minimally invasive pancreaticoduodenectomy does not improve use or time to initiation of adjuvant chemotherapy for patients with pancreatic adenocarcinoma. Ann Surg Oncol, 2016, 23(3): 1026-1033.
30.	Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.
31.	Sharpe SM, Talamonti MS, Wang CE, et al. Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: a comparison of laparoscopic panc-reaticoduodenectomy and open pancreaticoduodenectomy from the national cancer data base. J Am Coll Surg, 2015, 221(1): 175-184.
32.	Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
33.	Baimas-George M, Watson M, Salibi P, et al. Oncologic outcomes of robotic left pancreatectomy for pancreatic adenocarcinoma: A single-center comparison to laparoscopic resection. Am Surg, 2021, 87(1): 45-49.
34.	Nassour I, Tohme S, Hoehn R, et al. Safety and oncologic efficacy of robotic compared to open pancreaticoduodenectomy after neoadjuvant chemotherapy for pancreatic cancer. Surg Endosc, 2021, 35(5): 2248-2254.
35.	Ocuin LM, Miller-Ocuin JL, Novak SM, et al. Robotic and open distal pancreatectomy with celiac axis resection for locally advanced pancreatic body tumors: A single institutional assessment of perioperative outcomes and survival. HPB (Oxford), 2016, 18(10): 835-842.
36.	Topal H, Aerts R, Laenen A, et al. Survival after minimally invasive vs open surgery for pancreatic adenocarcinoma. JAMA Netw Open, 2022, 5(12): e2248147.
37.	Gupta N, Yelamanchi R. Pancreatic adenocarcinoma: A review of recent paradigms and advances in epidemiology, clinical diagnosis and management. World J Gastroenterol, 2021, 27(23): 3158-3181.
38.	Rosso E, Zimmitti G, Iannelli A, et al. The ‘TRIANGLE Operation’ by laparoscopy: radical pancreaticoduodenectomy with major vascular resection for borderline resectable pancreatic head cancer. Ann Surg Oncol, 2020, 27(5): 1613-1614.
39.	卓奇峰, 刘梦奇, 李征, 等. 胰腺癌新辅助化疗后腹腔镜手术治疗的效果分析. 中华外科杂志, 2022, 60(2): 134-139.
40.	姜翀弋. 腹腔镜或机器人辅助胰腺癌根治术中国专家共识(2022版). 中国实用外科杂志, 2023, 43(2): 121-127.
41.	徐均, 孟令威, 蔡云强, 等. 交界可切除胰头癌新辅助化疗后行联合静脉切除重建LPD的初步体会. 中国普外基础与临床杂志, 2021, 28(9): 1144-1147.
42.	He YG, Huang XB, Li YM, et al. Efficacy and safety of laparoscopic radical resection following neoadjuvant therapy for pancreatic ductal adenocarcinoma: A retrospective study. World J Gastrointest Oncol, 2022, 14(9): 1785-1797.
43.	Cai B, Lu Z, Neoptolemos JP, et al. Sub-adventitial divestment technique for resecting artery-involved pancreatic cancer: a retrospective cohort study. Langenbecks Arch Surg, 2021, 406(3): 691-701.
44.	Diener MK, Mihaljevic AL, Strobel O, et al. Periarterial divestment in pancreatic cancer surgery. Surgery, 2021, 169(5): 1019-1025.
45.	Klompmaker S, Boggi U, Hackert T, et al. Distal pancreatectomy with celiac axis resection (DP-CAR) for pancreatic cancer. How I do it. J Gastrointest Surg, 2018, 22(10): 1804-1810.
46.	Klotz R, Hackert T, Heger P, et al. The TRIANGLE operation for pancreatic head and body cancers: early postoperative outcomes. HPB (Oxford), 2022, 24(3): 332-341.
47.	Schneider M, Hackert T, Strobel O, et al. Technical advances in surgery for pancreatic cancer. Br J Surg, 2021, 108(7): 777-785.
48.	Habib JR, Kinny-Köster B, van Oosten F, et al. Periadventitial dissection of the superior mesenteric artery for locally advanced pancreatic cancer: Surgical planning with the “halo sign” and “string sign”. Surgery, 2021, 169(5): 1026-1031.
49.	Loos M, Kester T, Klaiber U, et al. Arterial resection in pancreatic cancer surgery: effective after a learning curve. Ann Surg, 2022, 275(4): 759-768.
50.	Bachellier P, Addeo P, Faitot F, et al. Pancreatectomy with arterial resection for pancreatic adenocarcinoma: How can it be done safely and with which outcomes?: A single institution’s experience with 118 patients. Ann Surg, 2020, 271(5): 932-940.
51.	Meng L, Gao P, Peng B. Laparoscopic pancreaticoduodenectomy with superior mesenteric vein resection and artificial vascular graft reconstruction for borderline resectable pancreatic cancer . J Gastrointest Surg, 2020, 24(12): 2906-2907.
52.	Garbarino GM, Fuks D, Cowan J, et al. Total laparoscopic pancreaticoduodenectomy with venous reconstruction for pancreatic head cancer with involvement of the superior mesenteric vein-portal vein confluence. Ann Surg Oncol, 2018, 25(13): 4035-4036.
53.	Kiguchi G, Sugioka A, Kojima M, et al. Distal pancreatectomy with en-bloc celiac axis resection (DP-CAR) through retroperitoneal-first laparoscopic approach (Retlap): A novel strategy for achieving accurate evaluation of resectability and minimal invasiveness. Surg Oncol, 2019, 28: 86-87.
54.	Kiguchi G, Sugioka A, Kato Y, et al. Laparoscopic distal pancreatectomy with regional lymphadenectomy through retroperitoneal-first laparoscopic approach (Retlap) for locally advanced pancreatic body cancer. Surg Oncol, 2020, 35: 301-302.
55.	Kiguchi G, Sugioka A, Kato Y, et al. Retroperitoneal-first laparoscopic approach (Retlap)-assisted distal pancreatectomy with celiac axis resection (DP-CAR): A novel minimally invasive approach for achieving adequate dorsal surgical margin. Surg Oncol, 2022, 41: 101729.

1. Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin, 2023, 73(1): 17-48.
2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3. Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med, 2018, 379(25): 2395-2406.
4. Buanes TA. Role of surgery in pancreatic cancer. World J Gastroenterol, 2017, 23(21): 3765-3770.
5. Truty MJ, Kendrick ML, Nagorney DM, et al. Factors predicting response, perioperative outcomes, and survival following total neoadjuvant therapy for borderline/locally advanced pancreatic cancer. Ann Surg, 2021, 273(2): 341-349.
6. Cloyd JM, Heh V, Pawlik TM, et al. Neoadjuvant therapy for resectable and borderline resectable pancreatic cancer: a meta-analysis of randomized controlled trials. J Clin Med, 2020, 9(4): 1129.
7. Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2021, 19(4): 439-457.
8. 中华人民共和国国家卫生健康委员会医政医管局. 胰腺癌诊疗指南(2022年版). 中华消化外科杂志, 2022, 21(9): 1117-1136.
9. Wang M, Li D, Chen R, et al. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol, 2021, 6(6): 438-447.
10. Qin R, Kendrick ML, Wolfgang CL, et al. International expert consensus on laparoscopic pancreaticoduodenectomy. Hepatobiliary Surg Nutr, 2020, 9(4): 464-483.
11. Barreto SG, Loveday B, Windsor JA, et al. Detecting tumour response and predicting resectability after neoadjuvant therapy for borderline resectable and locally advanced pancreatic cancer. ANZ J Surg, 2019, 89(5): 481-487.
12. 李征, 虞先濬, 徐晓武. 胰腺癌新辅助化疗后行腹腔镜胰十二指肠切除术的难点及对策. 中国实用外科杂志, 2022, 42(5): 526-528.
13. Elbanna KY, Jang HJ, Kim TK. Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review. Insights Imaging, 2020, 11(1): 58. .
14. Kim R, Prithviraj G, Kothari N, et al. PET/CT fusion scan prevents futile laparotomy in early stage pancreatic cancer. Clin Nucl Med, 2015, 40(11): e501-e505.
15. Ta R, O’Connor DB, Sulistijo A, et al. The role of staging laparoscopy in resectable and borderline resectable pancreatic cancer: A systematic review and meta-analysis. Dig Surg, 2019, 36(3): 251-260.
16. Gudmundsdottir H, Yonkus JA, Alva-Ruiz R, et al. Yield of staging laparoscopy for pancreatic cancer in the modern era: analysis of more than 1 000 consecutive patients. J Am Coll Surg, 2023, 237(1): 49-57.
17. Peng JS, Mino J, Monteiro R, et al. Diagnostic laparoscopy prior to neoadjuvant therapy in pancreatic cancer is high yield: an analysis of outcomes and costs. J Gastrointest Surg, 2017, 21(9): 1420-1427.
18. Suker M, Koerkamp BG, Coene PP, et al. Yield of staging laparoscopy before treatment of locally advanced pancreatic cancer to detect occult metastases. Eur J Surg Oncol, 2019, 45(10): 1906-1911.
19. Jayakrishnan TT, Nadeem H, Groeschl RT, et al. Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument. HPB (Oxford), 2015, 17(2): 131-139.
20. 徐强, 吴文铭, 韩显林, 等. 机器人胰体尾切除术学习曲线分析(附71例报告). 中国实用外科杂志, 2018, 38(7): 801-805, 810.
21. Wang M, Meng L, Cai Y, et al. Learning curve for laparoscopic pancreaticoduodenectomy: a CUSUM analysis. J Gastrointest Surg, 2016, 20(5): 924-935.
22. Wang X, Cai Y, Jiang J, et al. Laparoscopic pancreatico-duodenectomy: outcomes and experience of 550 patients in a single institution. Ann Surg Oncol, 2020, 27(11): 4562-4573.
23. Wang M, Peng B, Liu J, et al. Practice patterns and perioperative outcomes of laparoscopic pancreaticoduodenectomy in China: A retrospective multicenter analysis of 1 029 patients. Ann Surg, 2021, 273(1): 145-153.
24. Lof S, Korrel M, van Hilst J, et al. Impact of neoadjuvant therapy in resected pancreatic ductal adenocarcinoma of the pancreatic body or tail on surgical and oncological outcome: A propensity-score matched multicenter study. Ann Surg Oncol, 2020, 27(6): 1986-1996.
25. Deiro G, De Pastena M, Paiella S, et al. Assessment of difficulty in laparoscopic distal pancreatectomy: A modification of the Japanese difficulty scoring system—A single-center high-volume experience. J Hepatobiliary Pancreat Sci, 2021, 28(9): 770-777.
26. Torphy RJ, Friedman C, Halpern A, et al. Comparing short-term and oncologic outcomes of minimally invasive versus open pancreaticoduodenectomy across low and high volume centers. Ann Surg, 2019, 270(6): 1147-1155.
27. Chapman BC, Gajdos C, Hosokawa P, et al. Comparison of laparoscopic to open pancreaticoduodenectomy in elderly patients with pancreatic adenocarcinoma. Surg Endosc, 2018, 32(5): 2239-2248.
28. Kantor O, Talamonti MS, Sharpe S, et al. Laparoscopic pancreaticoduodenectomy for adenocarcinoma provides short-term oncologic outcomes and long-term overall survival rates similar to those for open pancreaticoduodenectomy. Am J Surg, 2017, 213(3): 512-515.
29. Nussbaum DP, Adam MA, Youngwirth LM, et al. Minimally invasive pancreaticoduodenectomy does not improve use or time to initiation of adjuvant chemotherapy for patients with pancreatic adenocarcinoma. Ann Surg Oncol, 2016, 23(3): 1026-1033.
30. Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.
31. Sharpe SM, Talamonti MS, Wang CE, et al. Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: a comparison of laparoscopic panc-reaticoduodenectomy and open pancreaticoduodenectomy from the national cancer data base. J Am Coll Surg, 2015, 221(1): 175-184.
32. Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
33. Baimas-George M, Watson M, Salibi P, et al. Oncologic outcomes of robotic left pancreatectomy for pancreatic adenocarcinoma: A single-center comparison to laparoscopic resection. Am Surg, 2021, 87(1): 45-49.
34. Nassour I, Tohme S, Hoehn R, et al. Safety and oncologic efficacy of robotic compared to open pancreaticoduodenectomy after neoadjuvant chemotherapy for pancreatic cancer. Surg Endosc, 2021, 35(5): 2248-2254.
35. Ocuin LM, Miller-Ocuin JL, Novak SM, et al. Robotic and open distal pancreatectomy with celiac axis resection for locally advanced pancreatic body tumors: A single institutional assessment of perioperative outcomes and survival. HPB (Oxford), 2016, 18(10): 835-842.
36. Topal H, Aerts R, Laenen A, et al. Survival after minimally invasive vs open surgery for pancreatic adenocarcinoma. JAMA Netw Open, 2022, 5(12): e2248147.
37. Gupta N, Yelamanchi R. Pancreatic adenocarcinoma: A review of recent paradigms and advances in epidemiology, clinical diagnosis and management. World J Gastroenterol, 2021, 27(23): 3158-3181.
38. Rosso E, Zimmitti G, Iannelli A, et al. The ‘TRIANGLE Operation’ by laparoscopy: radical pancreaticoduodenectomy with major vascular resection for borderline resectable pancreatic head cancer. Ann Surg Oncol, 2020, 27(5): 1613-1614.
39. 卓奇峰, 刘梦奇, 李征, 等. 胰腺癌新辅助化疗后腹腔镜手术治疗的效果分析. 中华外科杂志, 2022, 60(2): 134-139.
40. 姜翀弋. 腹腔镜或机器人辅助胰腺癌根治术中国专家共识(2022版). 中国实用外科杂志, 2023, 43(2): 121-127.
41. 徐均, 孟令威, 蔡云强, 等. 交界可切除胰头癌新辅助化疗后行联合静脉切除重建LPD的初步体会. 中国普外基础与临床杂志, 2021, 28(9): 1144-1147.
42. He YG, Huang XB, Li YM, et al. Efficacy and safety of laparoscopic radical resection following neoadjuvant therapy for pancreatic ductal adenocarcinoma: A retrospective study. World J Gastrointest Oncol, 2022, 14(9): 1785-1797.
43. Cai B, Lu Z, Neoptolemos JP, et al. Sub-adventitial divestment technique for resecting artery-involved pancreatic cancer: a retrospective cohort study. Langenbecks Arch Surg, 2021, 406(3): 691-701.
44. Diener MK, Mihaljevic AL, Strobel O, et al. Periarterial divestment in pancreatic cancer surgery. Surgery, 2021, 169(5): 1019-1025.
45. Klompmaker S, Boggi U, Hackert T, et al. Distal pancreatectomy with celiac axis resection (DP-CAR) for pancreatic cancer. How I do it. J Gastrointest Surg, 2018, 22(10): 1804-1810.
46. Klotz R, Hackert T, Heger P, et al. The TRIANGLE operation for pancreatic head and body cancers: early postoperative outcomes. HPB (Oxford), 2022, 24(3): 332-341.
47. Schneider M, Hackert T, Strobel O, et al. Technical advances in surgery for pancreatic cancer. Br J Surg, 2021, 108(7): 777-785.
48. Habib JR, Kinny-Köster B, van Oosten F, et al. Periadventitial dissection of the superior mesenteric artery for locally advanced pancreatic cancer: Surgical planning with the “halo sign” and “string sign”. Surgery, 2021, 169(5): 1026-1031.
49. Loos M, Kester T, Klaiber U, et al. Arterial resection in pancreatic cancer surgery: effective after a learning curve. Ann Surg, 2022, 275(4): 759-768.
50. Bachellier P, Addeo P, Faitot F, et al. Pancreatectomy with arterial resection for pancreatic adenocarcinoma: How can it be done safely and with which outcomes?: A single institution’s experience with 118 patients. Ann Surg, 2020, 271(5): 932-940.
51. Meng L, Gao P, Peng B. Laparoscopic pancreaticoduodenectomy with superior mesenteric vein resection and artificial vascular graft reconstruction for borderline resectable pancreatic cancer . J Gastrointest Surg, 2020, 24(12): 2906-2907.
52. Garbarino GM, Fuks D, Cowan J, et al. Total laparoscopic pancreaticoduodenectomy with venous reconstruction for pancreatic head cancer with involvement of the superior mesenteric vein-portal vein confluence. Ann Surg Oncol, 2018, 25(13): 4035-4036.
53. Kiguchi G, Sugioka A, Kojima M, et al. Distal pancreatectomy with en-bloc celiac axis resection (DP-CAR) through retroperitoneal-first laparoscopic approach (Retlap): A novel strategy for achieving accurate evaluation of resectability and minimal invasiveness. Surg Oncol, 2019, 28: 86-87.
54. Kiguchi G, Sugioka A, Kato Y, et al. Laparoscopic distal pancreatectomy with regional lymphadenectomy through retroperitoneal-first laparoscopic approach (Retlap) for locally advanced pancreatic body cancer. Surg Oncol, 2020, 35: 301-302.
55. Kiguchi G, Sugioka A, Kato Y, et al. Retroperitoneal-first laparoscopic approach (Retlap)-assisted distal pancreatectomy with celiac axis resection (DP-CAR): A novel minimally invasive approach for achieving adequate dorsal surgical margin. Surg Oncol, 2022, 41: 101729.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Minimally invasive treatment of pancreatic cancer following neo-adjuvant chemotherapy

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