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Comparison of minimal invasive versus open radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic ductal adenocarcinoma: a single center retrospective study

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Abstract

Introduction

Radical antegrade modular pancreatosplenectomy (RAMPS) was proposed a decade ago with the aim to achieve higher R0 tangential margin and radical N1 lymph node resection for left-sided pancreatic adenocarcinoma (PDAC), which has been widely accepted worldwide at present. Laparoscopic RAMPS (Lap-RAMPS) has been attempted for PDAC during last several years, however, no outcomes evaluation by comparison between laparoscopic vs open RAMPS has been reported yet.

Materials and methods

From August, 2012 to March, 2018, patients undergoing open or lap-RAMPS for the diagnosis of left-sided PDAC were reviewed from a prospective database. Patients excluded if they were related with combined organs or vessels resection, systematic metastasis as well as conversion from open RAMPS to lap RAMPS. The surgical and oncologic outcomes were compared.

Results

A total of 48 PDAC patients were enrolled (25 underwent lap-RAMPS and 23 underwent open-RAMPS). There were no significant differences in demographic or perioperative morbidity. In the lap-RAMPS group, R0 transection margin and retroperitoneal margin were both achieved in 23 of 25 patients (92%). In the open RAMPS group, R0 transection margin was achieved in 21 of 23 patients (91.3%), R0 retroperitoneal margin was 22 of 23 patients (95.65%). There were no differences in pathological examinations. The number of lymph node (LN) retrieved between lap-RAMPS and open- RAMPS group was not significant difference (15.84 vs 18.22; P = 0.268). Median disease-free survival (DFS) was analogous in two groups (18.11 m vs 20.00 m, P = 0.999). Median overall survival (OS) was 24.53 m in lap-RAMPS group and 28.73 m in the open-RAMPS group (P = 0.633).

Conclusions

Lap-RAMPS is technically feasible, and has comparable long-term oncological outcome with open-RMAPS.

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References

  1. Muniraj T, Jamidar PA, Aslanian HR (2013) Pancreatic cancer: a comprehensive review and update. Dis Mon 59(11):368–402\

    PubMed  Google Scholar 

  2. Harrison LE, Klimstra DS, Brennan MF (1996) Isolated portal vein involvement in pancreatic adenocarcinomacy. A contraindication for resection? Ann Surg 224:342–349

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Jimenez RE, Warshaw AL, Rattner DW, Willett CG, McGrath D, Castillo CF (2000) Impact of laparoscopic staging in the treatment of pancreatic cancer. Arch Surg 135:409–414

    CAS  PubMed  Google Scholar 

  4. Johnson CD, Schwall G, Flechtenmacher J, Trede M (1993) Resection for adenocarcinoma of the body and tail of the pancreas. Br J Surg 80:1177–1179

    CAS  PubMed  Google Scholar 

  5. Kalser MH, Barkin J, MacIntyre JM (1985) Pancreatic cancer. Assessment of prognosis by clinical presentation. Cancer 56:397–402

    CAS  PubMed  Google Scholar 

  6. Nakase A, Matsumoto Y, Uchida K, Honjo I (1977) Surgical treatment of cancer of the pancreas and the periampullary region: cumulative results in 57 institutions in Japan. Ann Surg 185:52–57

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Strasberg SM, Drebin JA, Linehan D (2003) Radical antegrade modular pancreatosplenectomy. Surgery 133(5):521–527

    PubMed  Google Scholar 

  8. O’morchoe CC (1997) Lymphatic system of the pancreas. Microsc Res Tech 37(5–6):456–477

    PubMed  Google Scholar 

  9. Strasberg SM, Linehan DC, Hawkins WG (2007) Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg 204(2):244–249

    PubMed  Google Scholar 

  10. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP (2017) The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more ”personalized” approach to cancer staging. CA: Cancer J Clin 67 (2):93–99

  11. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13

    PubMed  Google Scholar 

  12. Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591

  13. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768

    PubMed  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    PubMed  PubMed Central  Google Scholar 

  15. Siegel RL, Miller KD, Jemal A (2017) Cancer statistics. CA Cancer J Clin 67(1):7–30

    PubMed  Google Scholar 

  16. Yeh R, Steinman J, Luk L, Kluger MD, Hecht EM (2017) Imaging of pancreatic cancer: what the surgeon wants to know. Clin Imaging 42:203–217

    PubMed  Google Scholar 

  17. Sperti C, Pasquali C, Pedrazzoli S (1997) Ductal adenocarcinoma of the body and tail of the pancreas. J Am Coll Surg 185(3):255–259

    CAS  PubMed  Google Scholar 

  18. Kayahara M, Nagakawa T, Ueno K, Ohta T, Kitagawa H, Arakawa H, Yagi H, Tajima H, Miwa K (1998) Distal pancreatectomy: does it have a role for pancreatic body and tail cancer. Hepatogastroenterology 45(21):827–832

    CAS  PubMed  Google Scholar 

  19. Burcharth F, Trillingsgaard J, Olsen SD, Moesgaard F, Federspiel B, Struckmann JR (2003) Resection of cancer of the body and tail of the pancreas. Hepatogastroenterology 50(50):563–566

    PubMed  Google Scholar 

  20. Brennan MF, Moccia RD, Klimstra D (1996) Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg 223(5):506–502

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Christein JD, Kendrick ML, Iqbal CW, Nagorney DM, Farnell MB (2005) Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas. J Gastrointest Surg 9(7):922–927

    PubMed  Google Scholar 

  22. Shimada K, Sakamoto Y, Nara S, Esaki M, Kosuge T, Hiraoka N (2010) Analysis of 5-year survivors after a macroscopic curative pancreatectomy for invasive ductal adenocarcinoma. World J Surg 34(8):1908–1915

    PubMed  Google Scholar 

  23. Bollschweiler E (2003) Benefits and limitations of Kaplan-Meier calculations of survival chance in cancer surgery. Langenbecks Arch Surg 388:239–244

    PubMed  Google Scholar 

  24. Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526

    CAS  PubMed  Google Scholar 

  25. Park HJ, You D, Choi DW, Heo JS, Choi SH (2014) Role of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. World J Surg 38(1):186–193

    PubMed  Google Scholar 

  26. Trottman P, Swett K, Shen P, Sirintrapun J (2014) Comparison of standard distal pancreatectomy and splenectomy with radical antegrade modular pancreatosplenectomy. Am Surg 80(3):295–300

    PubMed  PubMed Central  Google Scholar 

  27. Abe T, Ohuchida K, Miyasaka Y, Ohtsuka T, Oda Y, Nakamura M (2016) Comparison of surgical outcomes between radical antegrade modular pancreatosplenectomy (RAMPS) and standard retrograde pancreatosplenectomy (SPRS) for left-sided pancreatic cancer. World J Surg 40(9):2267–2275

    PubMed  Google Scholar 

  28. Kang CM, Kim DH, Lee WJ (2010) Ten years of experience with resection of left-sided pancreatic ductal adenocarcinoma: evolution and initial experience to a laparoscopic approach. Surg Endosc 24(7):1533–1541

    PubMed  Google Scholar 

  29. Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL (2012) Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique a systematic review and meta-analysis. Ann surg 255(6):1048–1059

    PubMed  Google Scholar 

  30. Jin T, Altaf K, Xiong JJ, Huang W, Javed MA, Mai G, Liu XB, Hu WM, Xia Q (2012) A systematic review and meta-analysis of studies comparing laparoscopic and open distal pancreatectomy. HPB 14(11):711–724

    PubMed  PubMed Central  Google Scholar 

  31. Guerrini GP, Lauretta A, Belluco C, Olivieri M, Forlin M, Basso S, Breda B, Bertola G, Di Benedetto F (2017) Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis. BMC Surg 17(1):105s

    Google Scholar 

  32. Yamamoto M, Zaima M, Yamamoto H, Harada H, Kawamura J, Yamada M, Yazawa T, Kawasoe J (2017) New laparoscopic procedure for left-sided pancreatic cancer-artery-first approach laparoscopic RAMPS using 3D technique. World J Surg Oncol 15(1):213

    PubMed  PubMed Central  Google Scholar 

  33. Magge D (2013) Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma. JAMA Surg 148(6):525–531

    PubMed  Google Scholar 

  34. Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MG, Davidson BR, van Laarhoven CJ (2016) Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst Rev 4(4):CD011391

    PubMed  Google Scholar 

  35. Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 210(5):779–787

    PubMed  Google Scholar 

  36. Shin SH, Kim SC, Song KB, Hwang DW, Lee JH, Lee D, Lee JW, Jun E, Park KM, Lee YJ (2015) A comparative study of laparoscopic vs open distal pancreatectomy for left-sided ductal adenocarcinoma: a propensity score-matched analysis. J Am Coll Surg 220:2

    Google Scholar 

  37. Van HJ, De RT, Klompmaker S, Rawashdeh M, Aleotti F, Al-Sarireh B, Alseidi A, Ateeb Z, Balzano G, Berrevoet F, Björnsson B, Boggi U, Busch OR, Butturini G, Casadei R, Del Chiaro M, Chikhladze S, Cipriani F, van Dam R, Damoli I, van Dieren S, Dokmak S, Edwin B, van Eijck C, Fabre JM, Falconi M, Farges O, Fernández-Cruz L, Forgione A, Frigerio I, Fuks D, Gavazzi F, Gayet B, Giardino A, Groot Koerkamp B, Hackert T, Hassenpflug M, Kabir I, Keck T, Khatkov I, Kusar M, Lombardo C, Marchegiani G, Marshall R, Menon KV, Montorsi M, Orville M, de Pastena M, Pietrabissa A, Poves I, Primrose J, Pugliese R, Ricci C, Roberts K, Røsok B, Sahakyan MA, Sánchez-Cabús S, Sandström P, Scovel L, Solaini L, Soonawalla Z, Souche FR, Sutcliffe RP, Tiberio GA, Tomazic A, Troisi R, Wellner U, White S, Wittel UA, Zerbi A, Bassi C, Besselink MG, Abu Hilal M, European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS) (2019) Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study. Ann Surg 269:10–17

  38. Kim EY, Hong TH (2017) Initial experience with laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer in a single institution: technical aspects and oncological outcomes. BMC Surg 17(1):2

    PubMed  PubMed Central  Google Scholar 

  39. Kang CM, Lee SH, Lee WJ (2014) Minimally invasive radical pancreatectomy for left-sided pancreatic cancer: current status and future perspectives. World J Gastroenterol 20(9):2343–3235

    PubMed  PubMed Central  Google Scholar 

  40. Ome Y, Hashida K, Yokota M, Nagahisa Y, Michio O, Kawamoto K (2017) Laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer using the ligament of Treitz approach. Surg Endosc 31(11):4836–4837

    PubMed  Google Scholar 

  41. Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg 260:633–640

    PubMed  Google Scholar 

  42. Choi SH, Kang CM, Lee WJ, Chi HS (2011) Laparoscopic modified anterior RAMPS in well-selected left-sided pancreatic cancer: technical feasibility and interim results. Surg Endosc 25(7):2360–2361

    PubMed  Google Scholar 

  43. Chong JU, Kim SH, Hwang HK, Kang CM, Lee WJ (2017) Yonsei criteria: a clinical reflection of stage I left-sided pancreatic cancer. Oncotarget 8(67):110830–110836

    PubMed  PubMed Central  Google Scholar 

  44. Van HJ, De RT, Bosscha K, Brinkman DJ, van Dieren S, Dijkgraaf MG, Gerhards MF, de Hingh IH, Karsten TM, Lips DJ, Luyer MD, Busch OR, Festen S, Besselink MG, Dutch Pancreatic Cancer Group (2019) Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol 4(3):199–207

  45. Makino T, Shukla PJ, Rubino F, Milsom JW (2012) The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann Surg 255(2):228–236

    PubMed  Google Scholar 

  46. Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R, Buda A, Yan X, Shuzhong Y, Chetty N, Isla D, Tamura M, Zhu T, Robledo KP, Gebski V, Asher R, Behan V, Nicklin JL, Coleman RL, Obermair A (2018) Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 379(20):1895–1904

    PubMed  Google Scholar 

  47. Tomlinson JS, Jain S, Bentrem DJ, Sekeris EG, Maggard MA, Hines OJ, Reber HA, Ko CY (2007) Accuracy of staging node-negative pancreas cancer: a potential quality measure. Arch Surg 142(8):767–774

    PubMed  Google Scholar 

  48. Mitchem JB, Hamilton N, Gao F, Hawkins WG, Linehan DC, Strasberg SM (2012) Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg. 214(1):46–52

    PubMed  Google Scholar 

  49. Zhou Y, Shi B, Wu L, Si X (2017) A systematic review of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. HPB 19(1):10–15

    CAS  PubMed  Google Scholar 

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Acknowledgements

This work was supported by the Project of Capital Health Research and Development of Special (No. 2020-1-4011), Beijing, China.

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Author notes

  1. Hanyu Zhang and Yatong Li have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1, Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China

    Hanyu Zhang, Yatong Li, Quan Liao, Cheng Xing, Cheng Ding, Taiping Zhang, Junchao Guo, Xianlin Han, Qiang Xu, Wenming Wu, Yupei Zhao & Menghua Dai

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  1. Hanyu Zhang
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Correspondence to Menghua Dai.

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Dr. Han-Yu Zhang, Dr. Ya-Tong Li, Prof. Quan Liao, Dr.Cheng Xing, Dr. Cheng Ding, Prof. Tai-ping Zhang, Prof. Jun-Chao Guo, Dr. Xian-Lin Han, Dr. Qiang Xu, Prof. Wen-Ming Wu, Prof. Yu-Pei Zhao and Prof. Meng-Hua Dai have no conflicts of interest or financial ties to disclose.

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Zhang, H., Li, Y., Liao, Q. et al. Comparison of minimal invasive versus open radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic ductal adenocarcinoma: a single center retrospective study. Surg Endosc 35, 3763–3773 (2021). https://doi.org/10.1007/s00464-020-07938-1

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