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Comparison of Surgical Outcomes Between Radical Antegrade Modular Pancreatosplenectomy (RAMPS) and Standard Retrograde Pancreatosplenectomy (SPRS) for Left-Sided Pancreatic Cancer

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Abstract

Background

Radical antegrade modular pancreatosplenectomy (RAMPS) is a modification of standard retrograde pancreatosplenectomy (SRPS) used to achieve the dissection of N1 lymph nodes, early vascular control, and negative posterior margins. However, there have been few comparative studies regarding the clinical outcomes of the RAMPS and SRPS procedures.

Methods

Ninety-three patients underwent distal pancreatectomy for the treatment of pancreas body and tail adenocarcinoma between 2000 and 2014. Clinicopathologic data were retrospectively analyzed in this study. We compared short- and long-term outcomes between RAMPS and SRPS. In addition, we investigated the significance of clinicopathologic factors in left-sided pancreatic cancers.

Results

Fifty-three patients underwent RAMPS and 40 patients underwent SRPS. RAMPS revealed a larger number of retrieved lymph nodes [28.4 ± 11.6 vs 20.7 ± 10.1; P = 0.0016], more frequent R0 resection [90.5 vs 67.5 %; P = 0.0053], less intraoperative bleeding than SRPS [485.4 ± 63.3 vs 682.3 ± 72.8 ml; P = 0.0444], and shorter operating time (267.3 ± 11.5 vs 339.4 ± 13.2 min; P < 0.0001) as compared with SRPS. In comparing RAMPS and SRPS, RAMPS showed a tendency for improvement of the median survival times than SRPS (47 vs 34 months) (P = 0.1920). In the multivariate analysis, R1 resection, histologic grade, and vascular invasion for overall survival (OS) were found to be independent factors.

Conclusions

There were a decrease of intraoperative bleeding and an increase in the number of retrieved lymph nodes and the R0 resection rate using RAMPS as compared with SRPS.

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Abbreviations

RAMPS:

radical antegrade modular pancreatosplenectomy

SRPS:

standard retrograde pancreatosplenectomy

DP:

distal pancreatectomy

CEA:

carcinoembryonic antigen

CA19-9:

carbohydrate antigen 19-9

CY:

intraoperative peritoneal washing cytology

OS:

overall survival

DFS:

disease-free survival

ROC:

receiver operating characteristic

AUC:

area under the curve

CRT:

chemoradiotherapy

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Acknowledgments

This work was supported in part by a Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (B) and (C) and Scientific Research on Innovative Areas (Grant Number: 26108010).

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Authors and Affiliations

  1. Department of Surgery Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Toshiya Abe, Kenoki Ohuchida, Yoshihiro Miyasaka, Takao Ohtsuka & Masafumi Nakamura

  2. Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Yoshinao Oda

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  1. Toshiya Abe
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  2. Kenoki Ohuchida
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  3. Yoshihiro Miyasaka
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  4. Takao Ohtsuka
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  6. Masafumi Nakamura
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Correspondence to Toshiya Abe.

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Abe, T., Ohuchida, K., Miyasaka, Y. et al. Comparison of Surgical Outcomes Between Radical Antegrade Modular Pancreatosplenectomy (RAMPS) and Standard Retrograde Pancreatosplenectomy (SPRS) for Left-Sided Pancreatic Cancer. World J Surg 40, 2267–2275 (2016). https://doi.org/10.1007/s00268-016-3526-x

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  • DOI: https://doi.org/10.1007/s00268-016-3526-x

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