Clinical Outcome of RAMPS for Left-Sided Pancreatic Ductal Adenocarcinoma: A Comparison of Anterior RAMPS versus Posterior RAMPS for Patients without Periadrenal Infiltration.

Jaewoo Kwon,Eunsung Jun,Jae Hoon Lee,Woohyung Lee,Yejong Park,Ki Byung Song,Song Cheol Kim,Dae Wook Hwang

doi:10.3390/biomedicines9101291

Abstract

Radical antegrade modular pancreatosplenectomy (RAMPS) is considered an effective procedure for left-sided pancreatic ductal adenocarcinoma (PDAC). However, whether there are differences in perioperative outcomes, pathologies, or survival outcomes between anterior RAMPS (aRAMPS) and posterior RAMPS (pRAMPS) has not been reported previously. We retrospectively reviewed and compared the demographic, perioperative, histopathologic, and survival data of patients who underwent aRAMPS or pRAMPS for PDAC. We also compared these two groups among patients without periadrenal infiltration or adrenal invasion. A total of 112 aRAMPS patients and 224 pRAMPS patients were evaluated. Periadrenal infiltration, neoadjuvant treatment, and concurrent vessel resection were more prevalent in the pRAMPS group. After excluding patients with periadrenal infiltration, 106 aRAMPS patients were compared with 157 pRAMPS patients. There were no significant differences between the aRAMPS and pRAMPS groups in the pathologic tumor size, resection margin, proportion of tangential margin in the R1 resection, and number of harvested lymph nodes. The median overall survival and disease-free survival also did not differ significantly between the two groups. We cautiously suggest that pRAMPS will not necessarily provide more beneficial histopathologic outcomes and survival rates for left-sided PDAC cases without periadrenal infiltration. If periadrenal infiltration is not suspected, aRAMPS alone should be sufficiently effective.

Highlights

Pancreatic ductal adenocarcinoma (PDAC) is among the most aggressive cancer types.Left-sided PDAC, which is located in the pancreatic body or tail, typically has a poor prognosis because of non-specific symptoms and consequent late presentation or delayed diagnosis [1]
Radical antegrade modular pancreatosplenectomy (RAMPS) was first described by Strasberg [2] as a technique that provides more sufficient tangential margins and more harvested lymph nodes than standard distal pancreatectomy with splenectomy (SDP)
No publications have reported on the differences between anterior radical antegrade modular pancreatosplenectomy and posterior radical antegrade modular pancreatosplenectomy in terms of tangential margin status, lymph node retrieval, and survival outcomes

Summary

Introduction

Left-sided PDAC, which is located in the pancreatic body or tail, typically has a poor prognosis because of non-specific symptoms and consequent late presentation or delayed diagnosis [1]. Surgical resection is still a curative treatment, and distal pancreatectomy with splenectomy is the standard operative approach for left-sided PDAC. Radical antegrade modular pancreatosplenectomy (RAMPS) was first described by Strasberg [2] as a technique that provides more sufficient tangential margins and more harvested lymph nodes than standard distal pancreatectomy with splenectomy (SDP). Several studies have demonstrated that RAMPS increases the negative tangential margin rate and lymph node harvest yield [3,4,5]. No publications have reported on the differences between anterior radical antegrade modular pancreatosplenectomy (aRAMPS) and posterior radical antegrade modular pancreatosplenectomy (pRAMPS) in terms of tangential margin status, lymph node retrieval, and survival outcomes.

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