Abstract
Background
Laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) with vascular resection for pancreatic cancer has been rarely reported in the literature. Several critical steps are required to achieve a safe radical resection under laparoscopy while respecting oncologic principles of radicality.
Methods
Prospectively collected data on a consecutive series of patients undergoing radical antegrade modular pancreatosplenectomy (RAMPS) were retrospectively reviewed for the purpose of this study. Patients were divided into two groups based on the surgical approach and the need for vascular resection, and data were compared. The surgical technique is reported in detail focusing on the different modalities of vascular resection.
Results
Twenty-three patients (male/female ratio, 12/11; mean age, 73 years) underwent RAMPS between July 2014 and October 2018 at our institution. Of these, 17 had a laparoscopic approach and six a standard open approach. All patients in the open group underwent complex vascular reconstructions while four out of 17 (23.5%) underwent laparoscopic vascular resection. One patient in the laparoscopic approach required a vascular reconstruction with graft interposition, which combined the two approaches. There was no mortality, and the complication rate and the duration of surgery were comparable between the two groups.
Conclusion
L-RAMPS with vascular resection is feasible and safe in selected cases when performed by advanced pancreatic surgeons with experience in laparoscopic surgery.
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Electronic Supplementary Material
Video 1
Different steps of standard L-RAMPS with vascular resection are described. (WMV 227 mb).
Video 2
How to deal with an inaccessible splenic artery during L-RAMPS with vascular resection. (WMV 200 mb).
Video 3
Hybrid approach in an L-RAMPS with major venous resection. (WMV 44.2 mb).
Video 4
Critical steps to perform L-RAMPS with celiac trunk resection. (WMV 185 mb).
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Rosso, E., Frey, S., Zimmitti, G. et al. Laparoscopic Radical Antegrade Modular Pancreatosplenectomy with Vascular Resection for Pancreatic Cancer: Tips and Tricks. J Gastrointest Surg 24, 2896–2902 (2020). https://doi.org/10.1007/s11605-020-04695-3
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DOI: https://doi.org/10.1007/s11605-020-04695-3