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Laparoscopic versus open radical antegrade modular pancreatosplenectomy with artery–first approach in pancreatic cancer

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Abstract

Background

An artery-first approach for pancreatic cancer (PC) is challenging to perform laparoscopically and is mainly performed using an open approach. The aims of this study were to assess the safety and feasibility of laparoscopic radical antegrade modular pancreatosplenectomy (RAMPS) with an artery-first approach (L-aRAMPS) as compared with open aRAMPS (O-aRAMPS) in resectable PC using matched-pair analysis.

Methods

Artery-first approach is an early dissection of the superior mesenteric artery (SMA) from behind the pancreas body as the first surgical step. Data on L-aRAMPS and O-aRAMPS, performed between July 2013 and November 2019, were collected retrospectively. Additionally, the spatial characteristics of the splenic artery were analyzed using computed tomography.

Results

Thirty L-aRAMPS and 33 O-aRAMPS for resectable PC were included. After matching, 15 L-aRAMPS were compared with 15 O-aRAMPS. Median intraoperative blood loss and hospital stay were significantly improved in L-aRAMPS compared to O-aRAMPS (30 vs. 220 g, p < 0.001; 12 vs. 16 days, p = 0.049). The overall morbidity was similar in both study groups. The total number of lymph nodes dissected and those harvested from around the SMA and R0 resection was similar in both study groups. We classified the width of the cross section of the pancreas body into three equal parts: the upper, middle, and lower parts of the pancreas; 63% of the splenic artery origin was located in middle and lower parts of the pancreas body.

Conclusion

L-aRAMPS is technically safe and oncologically feasible to secure favorable surgical outcomes for resectable PC patients.

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Authors and Affiliations

  1. Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan

    Yasunari Kawabata, Hikota Hayashi, Shunsuke Kaji, Yusuke Fujii, Takeshi Nishi & Yoshitsugu Tajima

Authors
  1. Yasunari Kawabata
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  2. Hikota Hayashi
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  3. Shunsuke Kaji
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  4. Yusuke Fujii
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  5. Takeshi Nishi
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  6. Yoshitsugu Tajima
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Contributions

Study conception and design: Y Kawabata; Acquisition of the data: Y Kawabata, H Hayashi, S Kaji, Y Fujii, and K Nishi; Analysis and interpretation of the data: Y Kawabata and S Kaji; Drafting of the manuscript: Y Kawabata; Critical revision of the manuscript: Y Kawabata and Y Tajima.

Corresponding author

Correspondence to Yasunari Kawabata.

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The authors declare that they have no conflict of interest.

Ethical approval

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

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

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Kawabata, Y., Hayashi, H., Kaji, S. et al. Laparoscopic versus open radical antegrade modular pancreatosplenectomy with artery–first approach in pancreatic cancer. Langenbecks Arch Surg 405, 647–656 (2020). https://doi.org/10.1007/s00423-020-01887-y

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  • DOI: https://doi.org/10.1007/s00423-020-01887-y

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