The Role of Radical Antegrade Modular Pancreatosplenectomy Compared to Conventional Distal Pancreatosplenectomy in Patients with Left-sided Pancreatic Cancer: A Retrospective Multicenter Propensity- Score Matching Analysis

Abstract

Introduction: The purpose of this study aimed to evaluate the role of radical antegrade modular pancreatosplenectomy (RAMPS) in terms of postoperative outcomes compared to conventional distal pancreatosplenectomy (DPS) in patients with left- sided pancreatic ductal adenocarcinoma (PDAC). Method: From 2005 to 2017, consecutive 316 left-sided PDAC patients who underwent RAMPS (n=236) or DPS (n=80) for curative intent in four tertiary referral hospitals in Korea were included in this study. Among these, after 1:2 Propensity score matching with age, sex, differentiation, T and N stage, 71 patients with DPS and 139 patients with RAMPS were analyzed for clinicopathological outcomes. Result: There was no difference in complication rate between the two groups. RAMPS was superior than DPS in terms of R0 rate (99.3% vs 88.6%, p< 0.01) and harvested LN numbers (16.3±10.57 vs. 10.3±7.06, p< 0.01). RAMPS showed prolonged DFS (median survival 11 vs 9months), but statistically not significant (p=0.148). In a subgroup analysis with node-negative patients (n=107), RAMPS showed superior disease-free survival than DPS with statistically marginal significance (MS 15 vs 9m, p= 0.05). After multivariate analysis, preoperative CA19-9≥37, tail cancer, poorly or undifferentiated carcinoma, R1 resection, and absence of adjuvant treatment were identified as independent risk factors for survival. Also, preoperative CA19-9≥37, advanced T stage, LN metastasis, poorly or undifferentiated carcinoma were independent risk. Conclusion: Although we could not find an eminent survival benefit of RAMPS, it could be considered a standard surgical method for left-sided PDAC because of the similar complication rate and several oncologic benefits.