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Langenbeck's Archives of Surgery

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01-03-2019 | Pancreatic Cancer | Original Article

Radical antegrade modular pancreatosplenectomy for all pancreatic body and tail tumors: rationale and results

Authors: Masillamany Sivasanker, Ashwin Desouza, Manish Bhandare, Vikram Chaudhari, Mahesh Goel, Shailesh V. Shrikhande

Published in: Langenbeck's Archives of Surgery | Issue 2/2019

Abstract

Background

Radical antegrade modular pancreatosplenectomy (RAMPS) has been propagated as the standard of care for pancreatic cancers involving the body and tail of the pancreas. This procedure has been shown to have promising results in enhancing the microscopically negative tangential resection margins as well as the lymph node yield.

Methods

This is a retrospective analysis of prospectively maintained database on the resections performed for all pancreatic body and tail tumors at Tata Memorial Centre.

Results

Sixty-five patients underwent RAMPS without any perioperative mortality. The various pathologies comprised of adenocarcinoma (41.5%), neuroendocrine tumors (12.3%), solid pseudopapillary epithelial neoplasm (15.3%), cystic neoplasms (15.2%), etc. The R0 resection rate was 87.7%. Among this cohort, 27 patients had pancreatic adenocarcinoma. The 3-year OS and DFS for distal pancreatic cancers were 56% and 38%, respectively, but 3-year OS and DFS for other distal pancreatic tumors were 97% and 73%, respectively. On multivariate analysis, R0 resection significantly improved disease-free survival (p = 0.023) for pancreatic cancer.

Conclusion

RAMPS procedure aids to achieve high negative tangential margins for all tumors involving the body and tail of the pancreas and not just pancreatic cancer in isolation. Since preoperative histologic diagnosis is not routinely indicated and also a number of other distal pancreatic tumors carry a relatively better prognosis compared with pancreatic cancer, our results provide further evidence that RAMPS should be considered as the procedure of choice for all operable tumors involving body and tail of the pancreas.

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Title: Radical antegrade modular pancreatosplenectomy for all pancreatic body and tail tumors: rationale and results
Authors: Masillamany Sivasanker
Ashwin Desouza
Manish Bhandare
Vikram Chaudhari
Mahesh Goel
Shailesh V. Shrikhande
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Keywords: Pancreatic Cancer
Pancreatic Cancer
Published in: Langenbeck's Archives of Surgery / Issue 2/2019
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-019-01763-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Radical antegrade modular pancreatosplenectomy for all pancreatic body and tail tumors: rationale and results

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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