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Anterior versus posterior radical antegrade modular pancreatosplenectomy for pancreatic body and tail cancer: an inverse probability of treatment weighting with survival analysis

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Abstract

Purpose

Radical antegrade modular pancreatosplenectomy (RAMPS) is a standard procedure for patients with pancreatic body and tail cancer. There are two types of RAMPS: anterior and posterior, but their indications and surgical outcomes remain unclear. We compared the surgical outcomes, postoperative course, and prognosis between anterior and posterior RAMPS.

Methods

Between 2007 and 2020, 105 consecutive patients who underwent RAMPS for pancreatic body and tail cancers were divided into an anterior RAMPS group (n = 30) and a posterior RAMPS group (n = 75). To adjust for differences in preoperative characteristics and intraoperative procedures, an inverse probability of treatment weighting (IPTW) analysis was done, using propensity scores.

Results

After IPTW adjustment, the postoperative body temperature of the posterior RAMPS group and the amount of drain discharge in the anterior RAMPS group were significantly lower, from postoperative days (PODs) 1 to 3, but there were no differences in postoperative complications, recurrence patterns, or prognosis between the two groups. Regarding the diagnostic ability of multidetector-row computed tomography (MD-CT) for direct tumor involvement of the left adrenal gland, the sensitivity and specificity were 100% and 90.0%, respectively.

Conclusion

Pancreatic body and tail cancer without apparent preoperative direct tumor involvement of the left adrenal gland on MD-CT may be sufficient indication for anterior RAMPS.

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Data availability

The datasets used and/or analyzed during the current study are available from the author on reasonable request.

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Acknowledgements

We thank Toru Ogura (Clinical Research Support Center, Mie University Hospital) for his assistance with data analysis.

Funding

This study received no funding.

Author information

Authors and Affiliations

  1. Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Naohisa Kuriyama, Koki Maeda, Toru Shinkai, Takahiro Ito, Kazuyuki Gyoten, Aoi Hayasaki, Takehiro Fujii, Yusuke Iizawa, Yasuhiro Murata, Akihiro Tanemura, Masashi Kishiwada & Shugo Mizuno

  2. Department of Radiology, Mie University School of Medicine, Tsu, Mie, Japan

    Motonori Nagata

  3. Department of General Medicine, Mie University School of Medicine, Tsu, Mie, Japan

    Shuhei Ichikawa

Authors
  1. Naohisa Kuriyama
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  14. Shugo Mizuno
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Contributions

Conception and design of work: NK, MK, SM. Acquisition of data: NK, KM, TS, TI, KG, AH, TF, YI, YM, AT and MN. Data analysis and interpretation: All authors participated in critical revision of the manuscript for important intellectual content. All authors approved the final version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Naohisa Kuriyama.

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Kuriyama, N., Maeda, K., Shinkai, T. et al. Anterior versus posterior radical antegrade modular pancreatosplenectomy for pancreatic body and tail cancer: an inverse probability of treatment weighting with survival analysis. Surg Today 53, 917–929 (2023). https://doi.org/10.1007/s00595-023-02651-7

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  • DOI: https://doi.org/10.1007/s00595-023-02651-7

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