Advertisement

Langenbeck's Archives of Surgery

, Volume 404, Issue 2, pp 247–252 | Cite as

Left kidney mobilization technique during radical antegrade modular pancreatosplenectomy (RAMPS)

  • Genki Watanabe
  • Hiromichi ItoEmail author
  • Takafumi Sato
  • Yoshihiro Ono
  • Yoshihiro Mise
  • Yosuke Inoue
  • Yu Takahashi
  • Akio Saiura
How-I-Do-It article
  • 187 Downloads

Abstract

Purpose

Radical antegrade modular pancreatosplenectomy (RAMPS) has been accepted as a standard operation for distal pancreatic cancer. While enbloc retroperitoneal dissection in the “medial to lateral” direction is one of the most important steps in this oncologic procedure, it is technically challenging due to the depth of organs under the left costal margin, and poor exposure of the resecting organs in this area will increase the risk of incomplete oncologic dissection.

Methods

To improve exposure of the left upper quadrant organs, left kidney was completely mobilized during RAMPS, and all the left upper quadrant organs were elevated and medialized by lap sponges packed in the retro-renal space. The operative and oncologic outcomes for patients who underwent our modified RAMPS with left kidney mobilization were evaluated.

Results

One hundred and forty-four patients with distal pancreatic cancer underwent this procedure from 2005 through 2016. The median operation time was 310 min (range, 132–899), and blood loss was 440 ml (25–2430). There was no complication associated to left kidney mobilization. The median number of harvested lymph nodes was 27 (3–87). While 77% of the tumors had microscopic retroperitoneal invasion, 96% of patients achieved negative retroperitoneal margin.

Conclusions

Left kidney mobilization is useful for safe and oncologically sound lateral retroperitoneal dissection during RAMPS for distal pancreatic cancer.

Keywords

Radical antegrade modular pancreatosplenectomy Kidney mobilization Surgical technique Distal pancreatic cancer 

Notes

Authors’ contributions

GW—conception or design of the work AND drafting of the work.

HI—conception or design of the work AND drafting AND critical revision of the work.

TS—conception or design of the work AND critical revision of the work.

YO—conception or design of the work AND critical revision of the work.

YM—conception or design of the work AND critical revision of the work.

YI—conception or design of the work AND critical revision of the work.

TI—conception or design of the work AND critical revision of the work.

YT—conception or design of the work AND critical revision of the work.

AS—conception or design of the work AND critical revision of the work.

All authors approved the version of the manuscript to be published and agreed to be accountable for all aspects of the work. None of the authors have any actual or potential conflict of interest in relation to the submission of this article.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual patients included in the study.

Supplementary material

ESM 1

(MOV 214561 kb)

References

  1. 1.
    Strasberg SM, Drebin JA, Linehan D (2003) Radical antegrade modular pancreatosplenectomy. Surgery 133:521–527CrossRefPubMedGoogle Scholar
  2. 2.
    Trede M, Carter DC (1997) Left hemopancreatectomy. In: Surgery of the pancreas, 2nd edn. Churchill Livingstone, UK, pp 517–520Google Scholar
  3. 3.
    Von Hoff DD, Evans DB, Hruban RH (2005) Distal pancreatectomy. In: Pancreatic cancer, Jones and Bartlett Publishers pp 299–311Google Scholar
  4. 4.
    Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229:693–700CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ozaki H, Kinoshita T, Kosuge T, Yamamoto J, Shimada K, Inoue K, Koyama Y, Mukai K (1996) An aggressive therapeutic approach to carcinoma of the body and tail of the pancreas. Cancer 77:2240–2245CrossRefPubMedGoogle Scholar
  6. 6.
    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 204:244–249CrossRefPubMedGoogle Scholar
  7. 7.
    Strasberg SM, Fields R (2012) Left-sided pancreatic cancer. Cancer J 18:562–570CrossRefPubMedGoogle Scholar
  8. 8.
    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 214:46–52CrossRefPubMedGoogle Scholar
  9. 9.
    Grossman JG, Fields RC, Hawkins WG, Strasberg SM (2016) Single institution results of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of pancreas in 78 patients. J Hepatobiliary Pancreat Sci 23:432–441CrossRefPubMedGoogle Scholar
  10. 10.
    Shoup M, Conlon KC, Klimstra D, Brennan MF (2003) Is extended resection for adenocarcinoma of the body or tail of the pancreas justified? J Gastrointest Surg 7:946–952CrossRefPubMedGoogle Scholar
  11. 11.
    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 9:922–927CrossRefPubMedGoogle Scholar
  12. 12.
    Shimada K, Sakamoto Y, Sano T, Kosuge T (2006) Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail. Surgery 139:288–295CrossRefPubMedGoogle Scholar
  13. 13.
    Park HJ, Do 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 38:186–193CrossRefPubMedGoogle Scholar
  14. 14.
    de Rooij T, Tol JA, van Eijck CH et al (2016) Outcomes of distal pancreatectomy for pancreatic ductal adenocarcinoma in the Netherlands: a nationwide retrospective analysis. Ann Surg Oncol 23:585–591CrossRefPubMedGoogle Scholar
  15. 15.
    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 40:2267–2275CrossRefPubMedGoogle Scholar
  16. 16.
    Kajitani T (1992) Surgical atlas of the gastrointestinal tract cancer. Kanehara & Co., Ltd, Tokyo, pp 86–87Google Scholar
  17. 17.
    Chun YS (2018) Role of radical antegrade modular pancreatosplenectomy (RAMPS) and pancreatic cancer. Ann Surg Oncol 25:46–50CrossRefPubMedGoogle Scholar
  18. 18.
    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 19:10–15CrossRefPubMedGoogle Scholar
  19. 19.
    Mavros MN, Xu L, Maqsood H, Gani F, Ejaz A, Spolverato G, Al-Refaie WB, Frank SM, Pawlik TM (2015) Perioperative blood transfusion and the prognosis of pancreatic cancer surgery: systematic review and meta-analysis. Ann Surg Oncol 22:4382–4391CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Genki Watanabe
    • 1
  • Hiromichi Ito
    • 1
    Email author
  • Takafumi Sato
    • 1
  • Yoshihiro Ono
    • 1
  • Yoshihiro Mise
    • 1
  • Yosuke Inoue
    • 1
  • Yu Takahashi
    • 1
  • Akio Saiura
    • 1
    • 2
  1. 1.Division of Hepatobiliary and Pancreatic Surgery, Japanse Foundation for Cancer ResearchCancer Insitute HospitalTokyoJapan
  2. 2.Department of SurgeryJuntendo University HospitalTokyoJapan

Personalised recommendations