Minimally Invasive Distal Pancreatectomy for the Management of Left-Sided Pancreatic Cancer

Curative surgical resection is considered the most effective treatment option to achieve long–term survival in patients with pancreatic cancer. In performing a Distal Pancreatectomy (DP) for left–sided pancreatic cancer, there are two main approaches to dissection: proceeding from left to right and from right to left. The conventional DP procedure was the Standard Retrograde Pancreatosplenectomy (SRPS), with a left–to–right dissection, and then the radical antegrade Modular Pancreatosplenectomy (RAMPS), with a right–to–left dissection, was developed. A greater number of harvested lymph nodes and an increase in R0 resection have been achieved in RAMPS as compared to SRPS; however, oncological outcomes, including patient survival, are comparable in these procedures. Recently, Minimally Invasive Distal Pancreatectomy (MIDP) using laparoscopy for pancreatic cancer has been advanced. The MIDP also has not been enough to show oncological benefits as compared with an open DP. Additional randomized controlled trials should be conducted to clarify the impacts and benefits of each surgical approach in performing DP for cancer of the body or tail of the pancreas