Surgery for locally advanced periampullary tumours

This review evaluated the risks and survival benefits of pancreatoduodenectomy associated with venous resection compared with palliative surgery. A systematic review with meta-analysis was performed. Higher overall survival was observed in the pancreatic resection group (HR = 4.000; 95% CI 2.800 to 5.200). However, the palliative group had fewer complications (RD = -0.170; 95% CI -0.260 to -0.070). There was no significant difference in the mortality rates (RD = 0.000; 95% CI -0.030 to 0.030). In centres with experience in pancreatic surgery, resection may be considered for locally advanced cancer and major venous invasion...

Recent advances in technology and techniques have opened the gates widely to a wide range of applications of minimally invasive surgery in patients with inflammatory and neoplastic diseases of the pancreas. Laparoscopic cholecystectomy is the gold standard treatment for prevention of further attacks of acute biliary pancreatitis. Bile duct calculi detected at intraoperative cholangiography in patients with mild attacks of pancreatitis may be safely managed with laparoscopic bile duct exploration. Laparoscopic internal drainage of large, persistent and symptomatic pancreatic pseudocysts is safely applicable to most patients, achieves adequate drainage and facilitates debridement, and brings recognised benefits over open surgery and endoscopic approaches...