Ann Surg Treat Res.  2016 Jul;91(1):29-36. 10.4174/astr.2016.91.1.29.

Initial experience with radical antegrade modular pancreatosplenectomy in a single institution

• Kim EY
• You YK
• Kim DG
• Hong TH

• KMID: 2327414
• DOI: http://doi.org/10.4174/astr.2016.91.1.29

Abstract

PURPOSE
Radical antegrade modular pancreatosplenectomy (RAMPS) is expected to be favorable for obtaining the negative tangential margin with oncologic feasibility through the horizontal dissection in a right-to-left fashion for radical lymph node dissections.
METHODS
From January 2007 to February 2015, a total of 30 RAMPS and 19 conventional distal pancreatectomy (DP) cases were enrolled. The demographics, perioperative and survival outcomes were compared according to the type of surgery.
RESULTS
The mean operative time, blood loss and length of hospital stay were similar between 2 groups. Morbidities were reported in 14 cases of RAMPS (46.7%) and 8 cases of DP (42.1%) (P = 0.777). The rate of negative tangential margin (96.2%) and the number of harvested lymph nodes (mean ± standard deviation, 21.5 ± 8.3) were significantly higher in RAMPS group (P = 0.011, P = 0.003, respectively). In terms of survival outcomes, there was no significant difference in regard to the overall 3-year disease-free survival (DFS; 30.4% in RAMPS vs. 35.0% in DP, P = 0.354) or overall survival (OS; 29.9% vs. 29.4%, P = 0.429) between the 2 groups. After exclusion of cases with nodal invasion, however, the RAMPS group had a longer DFS than the DP group (55.6% vs. 27.3%, P = 0.048) although OS was similar without significant difference (42.4% vs. 27.3%, P = 0.197).
CONCLUSION
RAMPS is a safe and oncologically feasible procedure in left-sided pancreatic cancer by obtaining a successful negative tangential margin and radical lymph node dissection. The authors suggest it could also be useful for local control, especially for the limited left-sided pancreatic cancer without nodal invasion.

Keyword

Radical antegrade modular pancreatosplenectomy; Distal pancreatectomy; Left-sided pancreas cancer

MeSH Terms

Architectural Accessibility
Demography
Disease-Free Survival
Length of Stay
Lymph Node Excision
Lymph Nodes
Operative Time
Pancreatectomy
Pancreatic Neoplasms

Figure

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  Fig. 1 View of posterior radical antegrade modular pancreatosplenectomy after the completion of the resection stage. The range of lymph node dissection included the lymphoid tissues upwards to the diaphragmatic crus, downwards to the left renal vein and the left lateral portion of the aorta on the posterior side.

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  Fig. 2 A Kaplan-Meier survival curve of radical antegrade modular pancreatosplenectomy (RAMP) and distal pancreatectomy in all pancreas ductal adenocarcinoma (PDAC) cases (n = 43) and in PDAC cases without nodal invasion (n = 23); disease-free survival (A, C) and overall survival rate (B, D).

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