Initial experience with laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer in a single institution: technical aspects and oncological outcomes

Eun Young Kim,Tae Ho Hong

doi:10.1186/s12893-016-0200-z

Abstract

BackgroundLaparoscopic surgery has been performed less frequently in the era of pancreatic cancer due to technical difficulties and concerns about oncological safety. Radical antegrade modular pancreatosplenectomy (RAMPS) is expected to be helpful to obtain a negative margin during radical lymph node dissection. We hypothesized that it would also be favorable as a laparoscopic application due to unique features.MethodsFifteen laparoscopic RAMPS for well-selected patients with left-sided pancreatic cancer were performed from July 2011 to April 2016. Five trocars were usually used, and the operative procedures and range of dissection were similar to or the same as those of open RAMPS described by Strasberg. All medical records and follow-up data were reviewed and analyzed.ResultsAll patients had pancreatic ductal adenocarcinoma. Mean operative time was 219.3 ± 53.8 min, and estimated blood loss was 250 ± 70 ml. The length of postoperative hospital stay was 6.1 ± 1.2 days, and postoperative morbidities developed in two patients (13.3%) with urinary retention. The median number of retrieved lymph nodes was 18.1 ± 6.2 and all had negative margins. Median follow-up time was 46.0 months, and the 3-year disease free survival and overall survival rates were 56.3% and 74.1%, respectively.ConclusionOur early experience with laparoscopic RAMPS achieved feasible perioperative results accompanied by acceptable survival outcomes. Laparoscopic RAMPS could be a safe and oncologically feasible procedure in well-selected patients with left-sided pancreatic cancer.

Highlights

Laparoscopic surgery has been performed less frequently in the era of pancreatic cancer due to technical difficulties and concerns about oncological safety
The direction of dissection in Radical antegrade modular pancreatosplenectomy (RAMPS) is familiar to operators with conventional laparoscopic distal pancreatectomy experience for benign or borderline malignant tumors, and this RAMPS feature helps the operator feel more comfortable during laparoscopic RAMPS
Laparoscopic RAMPS was selectively applied to cases diagnosed as left-sided pancreatic cancer that was less than stage T3 without distant metastasis or peritoneal seeding on the preoperative imaging study

Summary

Introduction

Laparoscopic surgery has been performed less frequently in the era of pancreatic cancer due to technical difficulties and concerns about oncological safety. Radical antegrade modular pancreatosplenectomy (RAMPS) is expected to be helpful to obtain a negative margin during radical lymph node dissection. We hypothesized that it would be favorable as a laparoscopic application due to unique features. While the oncologic feasibility of laparoscopic surgery has been accepted for colon, stomach, and liver malignancies [1,2,3,4,5], only a few surgeons have performed laparoscopic surgery in the era of pancreatic cancer due to its fastidiousness for adequate dissection and the safety margin [6]. In 2003, Strasberg described an approach to resect left-sided pancreatic cancer called radical antegrade modular pancreatosplenectomy (RAMPS), which is a novel procedure that includes a horizontal dissection plane from right-to-left and radical resection of regional lymph nodes based on anatomic drainage of the pancreas. The direction of dissection (from right-to-left) in RAMPS is familiar to operators with conventional laparoscopic distal pancreatectomy experience for benign or borderline malignant tumors, and this RAMPS feature helps the operator feel more comfortable during laparoscopic RAMPS.

Objectives

Methods

Results

Discussion

Conclusion