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Laparoscopic Radical Antegrade Modular Pancreatosplenectomy with Anterocranial Splenic Artery-First Approach for Left-Sided Resectable Pancreatic Cancer (with Videos)

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Laparoscopic radical antegrade modular pancreatosplenectomy (Lap-RAMPS) for left-sided pancreatic cancer remains a technically challenging procedure. How to approach the splenic artery in laparoscopic surgery has not been discussed in adequate detail, and the implications of an artery-first approach in left-sided pancreatic cancer remain unclear.

Patients and Methods

Forty-five consecutive patients with left-sided resectable pancreatic cancer underwent Lap-RAMPS between July 2018 and September 2020. They were divided according to whether Lap-RAMPS was performed using an anterocranial splenic artery-first (ASF) approach (ASF group, n = 23) or via another approach (non-ASF group, n = 22). Clinical, pathological, and short-term outcomes were reviewed and compared between the groups.

Results

The ASF approach was performed safely in all patients with resectable left-sided pancreatic cancer, and none required conversion to laparotomy. The ASF group had better outcomes in terms of conspicuous bleeding from the spleen during splenic mobilization (P = 0.016) and blood pooling during posterior dissection (P = 0.035). Consequently, blood loss was significantly less and operation time was significantly shorter in the ASF group than in the non-ASF group. There was no significant between-group difference in other short-term outcomes, including mortality, length of hospital stay, or Clavien–Dindo classification.

Conclusions

The ASF approach was safe when performed for resectable left-sided pancreatic cancer and may help to prevent congestion of the pancreas and lessen intraoperative blood loss.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Tomotaka Kato MD, PhD, Yosuke Inoue MD, PhD, Atsushi Oba MD, PhD, Yoshihiro Ono MD, PhD, Takafumi Sato MD, PhD, Hiromichi Ito MD, PhD & Yu Takahashi MD, PhD

Authors
  1. Tomotaka Kato MD, PhD
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  2. Yosuke Inoue MD, PhD
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  3. Atsushi Oba MD, PhD
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  4. Yoshihiro Ono MD, PhD
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  5. Takafumi Sato MD, PhD
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  6. Hiromichi Ito MD, PhD
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  7. Yu Takahashi MD, PhD
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Correspondence to Yosuke Inoue MD, PhD.

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This video shows the details of laparoscopic radical antegrade modular pancreatosplenectomy (Lap-RAMPS) in a standard case. The patient was a 58-year-old man with cancer in the pancreatic tail (case 1). The tumor was located far from the superior mesenteric artery and the root of the splenic artery. The patient was diagnosed to have resectable pancreatic ductal adenocarcinoma. He was placed in the supine position with legs open, and the operation was performed using five trocars. The left adrenal gland was resected in this case to obtain sufficient tumor-free margins (MOV 177020 KB)

This video shows the details of laparoscopic radical antegrade modular pancreatosplenectomy (Lap-RAMPS) in a difficult case. The patient was a 53-year-old woman with cancer in the pancreatic body (case 2). The tumor was suspected to have invaded the splenic artery, splenic vein, and retroperitoneum but was not close to the superior mesenteric artery, celiac artery, common hepatic artery, or portal vein. The splenic artery was difficult to ligate because its origin was located deep in the peripancreatic fat. We devised the following surgical strategy: double ligation and division of the splenic artery after transection of the pancreas with addition of an extra epigastric port to adjust the angle of the approach to the splenic artery. (MOV 59947 KB)

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Kato, T., Inoue, Y., Oba, A. et al. Laparoscopic Radical Antegrade Modular Pancreatosplenectomy with Anterocranial Splenic Artery-First Approach for Left-Sided Resectable Pancreatic Cancer (with Videos). Ann Surg Oncol 29, 3505–3514 (2022). https://doi.org/10.1245/s10434-022-11382-x

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