Skip to main content

Advertisement

SpringerLink
Log in

Surgical and oncological outcomes of laparoscopic versus open radical antegrade modular pancreatosplenectomy for pancreatic ductal adenocarcinoma

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

To compare the outcomes of laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) with those of open RAMPS (O-RAMPS) in patients with pancreatic ductal adenocarcinoma (PDAC).

Methods

We reviewed, retrospectively, the medical records of 50 patients who underwent RAMPS for PDAC without resection of major vessels and adjacent organs between 2007 and 2019, and analyzed the relationship between the operative method and surgical and oncological outcomes.

Results

Nineteen of the 50 patients underwent L-RAMPS and 31 patients underwent O-RAMPS. L-RAMPS was associated with significantly less blood loss (P = 0.034) but a longer operative time (P = 0.001) than O-RAMPS. There were no significant differences in patient characteristics, tumor factors, or postoperative course; or in the rates of recurrence-free survival (P = 0.084) or overall survival (P = 0.402) between the L-RAMPS and O-RAMPS groups.

Conclusion

L-RAMPS for PDAC resulted in less blood loss but a longer operative time than O-RAMPS. Although L-RAMPS may be feasible, the operative time needs to be reduced by standardizing the procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Raimondi S, Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol. 2009;6:699–708.

    Article  Google Scholar 

  2. Björnsson B, Larsson AL, Hjalmarsson C, Gasslander T, Sandström P. Comparison of the duration of hospital stay after laparoscopic or open distal pancreatectomy: randomized controlled trial. Br J Surg. 2020;107:1281–8.

    Article  Google Scholar 

  3. Matsumoto I, Kamei K, Satoi S, Murase T, Matsumoto M, Kawaguchi K, et al. Laparoscopic versus open distal pancreatectomy for benign and low-grade malignant lesions of the pancreas: a single-center comparative study. Surg Today. 2019;49:394–400.

    Article  Google Scholar 

  4. Ohtsuka T, Ban D, Nakamura Y, Nagakawa Y, Tanabe M, Gotoh Y, et al. Difficulty scoring system in laparoscopic distal pancreatectomy. J Hepatobiliary Pancreat Sci. 2018;25:489–97.

    Article  Google Scholar 

  5. Stauffer JA, Coppola A, Mody K, Asbun HJ. Laparoscopic versus open distal pancreatectomy for pancreatic adenocarcinoma. World J Surg. 2016;40:1477–84.

    Article  Google Scholar 

  6. Chen K, Tong Q, Yan JF, Huang CJ, Pan Y, Zhang RC, et al. Laparoscopic versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a single-center propensity score matching study. Updates Surg. 2020;72:387–97.

    Article  Google Scholar 

  7. Miyasaka Y, Ohtsuka T, Nakamura M. Minimally invasive surgery for pancreatic cancer. Surg Today. 2021;51:194–203.

    Article  Google Scholar 

  8. Miao Y, Lu Z, Yeo CJ, Vollmer CM Jr, Fernandez-Del Castillo C, Ghaneh P, et al. Management of the pancreatic transection plane after left (distal) pancreatectomy: expert consensus guidelines by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2020;168:72–84.

    Article  Google Scholar 

  9. Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003;133:521–7.

    Article  Google Scholar 

  10. Zhang H, Li Y, Liao Q, Xing C, Ding C, Zhang T, et al. Comparison of minimal invasive versus open radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic ductal adenocarcinoma: a single center retrospective study. Surg Endosc. 2020. https://doi.org/10.1007/s00464-020-07938-1.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ome Y, Hashida K, Yokota M, Nagahisa Y, Michio O, Kawamoto K. Laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer using the ligament of Treitz approach. Surg Endosc. 2017;31:4836–7.

    Article  Google Scholar 

  12. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 7th ed. New York: Wiley; 2011.

    Google Scholar 

  13. Bassi C, Marchegiani G, Dervinis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group (ISGPF) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161:584–91.

    Article  Google Scholar 

  14. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–8.

    Article  Google Scholar 

  15. Strasberg SM, Linehan DC, Hawkins WG. 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. 2007;204:244–9.

    Article  Google Scholar 

  16. Abe T, Ohuchida K, Miyasaka Y, Ohtsuka T, Oda Y, Nakamura M. Comparison of surgical outcomes between radical antegrade modular pancreatosplenectomy (RAMPS) and standard retrograde pancreatosplenectomy (SPRS) for left-sided pancreatic cancer. World J Surg. 2016;40:2267–75.

    Article  Google Scholar 

  17. Chun YS. Role of radical antegrade modular pancreatosplenectomy (RAMPS) and pancreatic cancer. Ann Surg Oncol. 2018;25:46–50.

    Article  Google Scholar 

  18. Shimada K, Sakamoto Y, Sano T, Kosuge T. Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail. Surgery. 2006;139:288–95.

    Article  Google Scholar 

  19. Kawabata Y, Hayashi H, Kaji S, Fujii Y, Nishi T, Tajima Y. Laparoscopic versus open radical antegrade modular pancreatosplenectomy with artery-first approach in pancreatic cancer. Langenbecks Arch Surg. 2020;405:647–56.

    Article  Google Scholar 

  20. Yang DJ, Xiong JJ, Lu HM, Wei Y, Zhang L, Lu S, et al. The oncological safety in minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. Sci Rep. 2019;9:1159.

    Article  Google Scholar 

  21. van Hilst J, de Rooij T, Klompmaker S, Rawashdeh M, Aleotti F, Al-Sarireh B, et al. Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study. Ann Surg. 2019;269:10–7.

    Article  Google Scholar 

  22. de Rooij T, Cipriani F, Rawashdeh M, van Dieren S, Barbaro S, Abuawwad M, et al. Single-surgeon learning curve in 111 laparoscopic distal pancreatectomies: does operative time tell the whole story? J Am Coll Surg. 2017;224:826–32.

    Article  Google Scholar 

  23. Nakamura Y, Matsushita A, Katsuno A, Sumiyoshi H, Yoshioka M, Shimizu T, et al. Laparoscopic distal pancreatectomy: educating surgeons about advanced laparoscopic surgery. Asian J Endosc Surg. 2014;7:295–300.

    Article  Google Scholar 

  24. Hua Y, Javed AA, Burkhart RA, Makary MA, Weiss MJ, Wolfgang CL, et al. Preoperative risk factors for conversion and learning curve of minimally invasive distal pancreatectomy. Surgery. 2017;162:1040–7.

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan

    Teijiro Hirashita, Yukio Iwashita, Atsuro Fujinaga, Hiroaki Nakanuma, Kazuhiro Tada, Takashi Masuda, Yuichi Endo, Masayuki Ohta & Masafumi Inomata

Authors
  1. Teijiro Hirashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yukio Iwashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atsuro Fujinaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroaki Nakanuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuhiro Tada
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takashi Masuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuichi Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masayuki Ohta
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masafumi Inomata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Teijiro Hirashita.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hirashita, T., Iwashita, Y., Fujinaga, A. et al. Surgical and oncological outcomes of laparoscopic versus open radical antegrade modular pancreatosplenectomy for pancreatic ductal adenocarcinoma. Surg Today 52, 224–230 (2022). https://doi.org/10.1007/s00595-021-02326-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-021-02326-1

Keywords

Search

Navigation