Clinical effect of radical antegrade modular pancreatosplenectomy for carcinoma of pancreatic body and tail

Abstract

Objective To explore the safety and feasibility of radical antegrade modular pancreato-splenectomy (RAMPS) for carcinoma of pancreatic body and tail (CPBT). Methods The retrospective cohort study was adopted. The clinical data of 99 patients with CPBT who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2013 to October 2015 were collected. Among the 99 patients, 21 receiving RAMPS were allocated into the RAMPS group and 78 receiving traditional resection of body and tail of pancreas and splenectomy were allocated into the operation group. Observation indexes included (1) surgical situation: operation time, volume of intraoperative blood loss, volume of blood transfusion, combined organ resection, combined vascular resection, status of the resection margin, (2) postoperative situation: overall complications, major postoperative complications [pancreatic fistula, chyle leakage, abdominal bleeding, hemorrhage of digestive tract, delayed gastric emptying, pleural effusion, pulmonary infection, peritoneal effusion, abdominal infection, wound infection, deep venous thrombosis in the lower limbs, multiple organ dysfunction syndrome (MODS)], reoperation, duration of hospital stay, hospital expenses, (3) follow-up: the postoperative survival of patients, tumor recurrence and metastasis. The follow-up using outpatient examination and telephone interview was performed to detect the patients′ survival and tumor recurrence and metastasis up to March 2016. Measurement data with normal distribution were presented as ±s and comparison between groups was evaluated with the Student t test. Measurement data with skewed distribution were presented as M(Qn) and comparison between groups was evaluated with the Wilcoxon rank sum test. Count data were analyzed using the chi-square test or Fisher exact probability. The survival time was calculated by the Kaplan-Meier method. Results (1) Surgical situation: operation time, volume of intraoperative blood loss, volume of blood transfusion and number of patients combined with organ resection were 235 minutes(180 minutes, 278 minutes), 400 mL (350 mL, 650 mL), 3.1 U (2.5 U , 5.6 U), 13 in the RAMPS group and 180 minutes (130 minutes, 210 minutes), 225 mL (200 mL, 400 mL), 0 (0, 2.0 U), 10 in the operation group, respectively, with statistically significant differences between the 2 groups (Z=3.529, 2.675, 3.389, P 0.05). (2) Postoperative situation: number of patients with overall complications, pancreatic fistula in grade A, pancreatic fistula in grade B, pancreatic fistula in grade C, chyle leakage, abdominal bleeding, hemorrhage of digestive tract, delayed gastric emptying, pleural effusion, pulmonary infection, peritoneal effusion, abdominal infection, wound infection, deep venous thrombosis in the lower limbs, MODS and reoperation were 16, 6, 5, 2, 1, 1, 0, 1, 7, 0, 6, 4, 1, 0, 0, 0 in the RAMPS group and 48, 15, 19, 2, 5, 4, 2, 1, 18, 4, 15, 5, 1, 2, 1, 1 in the operation group, respectively, with no statistically significant differences between the 2 groups (χ2=1.554, 1.642, P>0.05). The duration of hospital stay and hospital expenses were 15 days (13 days, 23 days), 74 632 Yuan (67 041 Yuan , 92 445 Yuan) in the RAMPS group and 12 days (10 days, 16 days), 64 410 Yuan (54 709 Yuan, 80 842 Yuan) in the operation group, respectively, showing statistically significant differences between the 2 groups (Z=3.529, 2.675, P 0.05). Conclusion RAMPS in the treatment of CPBT is safe and feasible, and it could not increase the incidence of complications, however, enhance the R0 resection rate compared with traditional resection of body and tail of pancreas and splenectomy. Key words: Neoplasms, body and tail of pancreas; Radical antegrade modular pancreatosplenectomy; Radical resection of body and tail of pancreas