Abstract
BackgroundRadical antegrade modular pancreatosplenectomy (RAMPS) is a relatively new modification of the standard distal pancreatosplenectomy. In this method, dissection proceeds from right-to-left to achieve negative posterior resection margins. However, short-term and long-term outcomes of RAMPS for pancreatic cancer have not yet been clarified. The aim of this study is to evaluate short-term and long-term outcomes in the patients who have undergone RAMPS.MethodsConsecutive 49 patients were selected from the retrospective database of the Kanagawa Cancer Center from 2000 to 2014. Data from the operative notes, pathology reports, postoperative data, and outpatient data (recurrence and survival) were entered into the database.ResultsAll patients were undergone anterior RAMPS. The median operation time was 278 min (range from 140 to 625 mins). The median blood loss in operation was 850 ml (range from 60 to 2790 ml). The overall incidence of morbidity was 51.4 % and the incidence of mortality was 0 %. Forty-one patients (83.7 %) had negative resection margins. The mean number of lymph nodes harvested was 15 and 27 patients had lymph node metastasis. After the median follow-up period was 41.1 months, 1-year and 3-year overall survival rates were 84.1 and 38.6 %, respectively. Median overall survival was 22.6 months.ConclusionsThe present study results suggested that RAMPS procedure might be safe and feasible without an increase in morbidity and morbidity and have survival benefit compared with standard DP.
Highlights
Radical antegrade modular pancreatosplenectomy (RAMPS) is a relatively new modification of the standard distal pancreatosplenectomy
Adenocarcinoma of the pancreatic body and tail are as aggressive as pancreatic head tumors in terms of local invasion and their propensity for lymph node metastasis
The patients were selected according to the following criteria: (1) a histologically proven pancreatic adenocarcinoma located in the body and tail of pancreas according to the seventh edition of the International Union Against Cancer (UICC) TNM [7]; (2) the patients underwent distal pancreatosplenectomy as the primary treatment for pancreatic adenocarcinoma; (3) the patients underwent surgery that consisted of dissection of more than the N1 lymph nodes and which achieved a curative or R1 resection; (4) the patients did not have synchronous or metachronous malignancies
Summary
Radical antegrade modular pancreatosplenectomy (RAMPS) is a relatively new modification of the standard distal pancreatosplenectomy. In this method, dissection proceeds from right-to-left to achieve negative posterior resection margins. Short-term and long-term outcomes of RAMPS for pancreatic cancer have not yet been clarified. The aim of this study is to evaluate short-term and long-term outcomes in the patients who have undergone RAMPS. Distal pancreatectomy (DP) has been the standard procedure for the resection of tumors of the body and tail of the pancreas for over 100 years [2]. It is essential to perform a complete resection of the tumor with a margin of normal tissue and to resect the regional lymph nodes. The traditional approach of left-to-right pancreatosplenectomy is associated with a high rate of tangential margin positivity [3, 4], and is not based on the lymphatic drainage of the organ
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