Top

World Journal of Surgery

Published in:

01-09-2016 | Original Scientific Report

Comparison of Surgical Outcomes Between Radical Antegrade Modular Pancreatosplenectomy (RAMPS) and Standard Retrograde Pancreatosplenectomy (SPRS) for Left-Sided Pancreatic Cancer

Authors: Toshiya Abe, Kenoki Ohuchida, Yoshihiro Miyasaka, Takao Ohtsuka, Yoshinao Oda, Masafumi Nakamura

Published in: World Journal of Surgery | Issue 9/2016

Abstract

Background

Radical antegrade modular pancreatosplenectomy (RAMPS) is a modification of standard retrograde pancreatosplenectomy (SRPS) used to achieve the dissection of N1 lymph nodes, early vascular control, and negative posterior margins. However, there have been few comparative studies regarding the clinical outcomes of the RAMPS and SRPS procedures.

Methods

Ninety-three patients underwent distal pancreatectomy for the treatment of pancreas body and tail adenocarcinoma between 2000 and 2014. Clinicopathologic data were retrospectively analyzed in this study. We compared short- and long-term outcomes between RAMPS and SRPS. In addition, we investigated the significance of clinicopathologic factors in left-sided pancreatic cancers.

Results

Fifty-three patients underwent RAMPS and 40 patients underwent SRPS. RAMPS revealed a larger number of retrieved lymph nodes [28.4 ± 11.6 vs 20.7 ± 10.1; P = 0.0016], more frequent R0 resection [90.5 vs 67.5 %; P = 0.0053], less intraoperative bleeding than SRPS [485.4 ± 63.3 vs 682.3 ± 72.8 ml; P = 0.0444], and shorter operating time (267.3 ± 11.5 vs 339.4 ± 13.2 min; P < 0.0001) as compared with SRPS. In comparing RAMPS and SRPS, RAMPS showed a tendency for improvement of the median survival times than SRPS (47 vs 34 months) (P = 0.1920). In the multivariate analysis, R1 resection, histologic grade, and vascular invasion for overall survival (OS) were found to be independent factors.

Conclusions

There were a decrease of intraoperative bleeding and an increase in the number of retrieved lymph nodes and the R0 resection rate using RAMPS as compared with SRPS.

Brennan MF, Moccia RD, Klimstra D (1996) Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg 223:506–512CrossRefPubMedPubMedCentral

Strasberg SM, Drebin JA, Linehan D (2003) Radical antegrade modular pancreatosplenectomy. Surgery 133:521–527CrossRefPubMed

Strasberg SM, Linehan DC, Hawkins WG et al (2007) Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg 204:244–249CrossRefPubMed

Mitchem JB, Hamilton N, Gao F et al (2012) Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg 214:46–52CrossRefPubMed

Park HJ, You DD, Choi SH et al (2014) Role of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. World J Surg 38:186–193CrossRefPubMed

Latorre M, Ziparo V, Nigri G et al (2013) Standard retrograde pancreatosplenectomy versus radical antegrade modular pancreatosplenectomy for body and tail pancreatic adenocarcinoma. Am Surg 79:1154–1158PubMed

Trottman P, Swett K, Shen P et al (2014) Comparison of standard distal pancreatectomy and splenectomy with radical antegrade modular pancreatosplenectomy. Am Surg 80:295–300PubMedPubMedCentral

Yamamoto J, Saiura A, Koga R et al (2010) Improved survival of left-sided pancreas cancer after surgery. Jpn J Clin Oncol 40:530–536CrossRefPubMed

Shimada K, Sakamoto Y, Sano T et al (2006) Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail. Surgery 139:288–295CrossRefPubMed

10.

Fujita T, Nakagohri T, Gotohda N et al (2010) Evaluation of the prognostic factors and significance of lymph node status in in-vasive ductal carcinoma of the body or tail of the pancreas. Pancreas 39:e48–e54CrossRefPubMed

11.

Kanda M, Fujii T, Sahin TT et al (2010) Invasion of the splenic artery is a crucial prognostic factor in carcinoma of the body and tail of the pancreas. Ann Surg 251:483–487CrossRefPubMed

12.

O’Morchoe CC (1997) Lymphatic system of the pancreas. Microsc Res Tech 37:456–477CrossRefPubMed

13.

Edge SB, Compton CC (2010) The American Joint Committee On Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474CrossRefPubMed

14.

Sobin LH, Gospodarowicz MK, Wittekind C (2010) TNM classification of malignant tumors, 7th edn. Wiley, New York

15.

Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRefPubMed

16.

Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMed

17.

Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761e–768eCrossRef

18.

Chang YR, Han SS, Park SJ et al (2012) Surgical outcome of pancreatic cancer using radical antegrade modular pancreatosplenectomy procedure. World J Gastroenterol 18:5595–5600CrossRefPubMedPubMedCentral

19.

Kang CM, Kim DH, Lee WJ (2010) Ten years of experience with resection of left-sided pancreatic ductal adenocarcinoma: evolution and initial experience to a laparoscopic approach. Surg Endosc 24:1533–1541CrossRefPubMed

20.

Jang JY, Kang MJ, Heo JS et al (2014) A prospective randomized controlled study comparing outcomes of standard resection and extended resection, including dissection of the nerve plexus and various lymph nodes, in patients with pancreatic head cancer. Ann Surg 259:656–664CrossRefPubMed

21.

Satoi S, Murakami Y, Motoi F et al (2015) Reappraisal of peritoneal washing cytology in 984 patients with pancreatic ductal adenocarcinoma who underwent margin-negative resection. J Gastrointest Surg 19:6–14CrossRefPubMed

Title: Comparison of Surgical Outcomes Between Radical Antegrade Modular Pancreatosplenectomy (RAMPS) and Standard Retrograde Pancreatosplenectomy (SPRS) for Left-Sided Pancreatic Cancer
Authors: Toshiya Abe
Kenoki Ohuchida
Yoshihiro Miyasaka
Takao Ohtsuka
Yoshinao Oda
Masafumi Nakamura
Publication date: 01-09-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 9/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3526-x

At a glance: The STEP trials

Springer Medicine

Comparison of Surgical Outcomes Between Radical Antegrade Modular Pancreatosplenectomy (RAMPS) and Standard Retrograde Pancreatosplenectomy (SPRS) for Left-Sided Pancreatic Cancer

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2016

Access to Safe Obstetric Surgical Care in Low-Income Countries

Single-Port Surgery in Inflammatory Bowel Disease: A Review of Current Evidence

A Positive Node on Ultrasound-Guided Fine Needle Aspiration Predicts Higher Nodal Burden Than a Positive Sentinel Lymph Node Biopsy in Breast Carcinoma

Prognostic Analysis of Surgical Resection for Pulmonary Metastasis from Hepatocellular Carcinoma

Non-Obstetric Surgical Care at Three Rural District Hospitals in Rwanda: More Human Capacity and Surgical Equipment May Increase Operative Care

Significant Improvement in Outcomes of Patients with Intrahepatic Cholangiocarcinoma after Surgery