Radical antegrade modular pancreatosplenectomy (RAMPS) versus conventional distal pancreatectomy for left-sided pancreatic cancer: findings of a multicenter, retrospective, propensity score matching study.

Abstract

PURPOSE:

Radical antegrade modular pancreatosplenectomy (RAMPS) has been reported to achieve high rates of a negative margin and resected metastatic lymph nodes. However, many studies have used historical controls and the results remain controversial. We conducted this study to compare the surgical and long-term outcomes of RAMPS vs. conventional distal pancreatectomy (DP).

METHODS:

The subjects of this multicenter retrospective study were 106 patients who underwent curative resection for left-sided pancreatic cancer between 2012 and 2017. Overall survival (OS) and recurrence-free survival (RFS) rates were compared using Kaplan-Meier estimates.

RESULTS:

The RAMPS group had more advanced T (T3/T4) and N stages (N1/N2) and a larger tumor size than the conventional group (T stage, p = 0.04; N stage, p = 0.02; tumor size, p = 0.04). The RAMPS group had more harvested metastatic lymph nodes (p = 0.02). After propensity-score matching, 37 patients from each group were included in the final analysis. There was no significant difference in RFS (p = 0.463) or OS (p = 0.383) between the groups. Multivariate analyses revealed the completion of chemotherapy to be an independent factor for RFS and OS (both p < 0.001).

CONCLUSIONS:

There was no difference in the RFS or OS between RAMPS and conventional DP in this series. RAMPS may be an option for R0 resection of advanced tumors; however, postoperative chemotherapy has a greater influence than the surgical procedure on the prognosis of patients with pancreatic cancer.

• Authors: Hyung Sun Kim, Tae Ho Hong, Young-Kyoung You, Joon Seong Park, Dong Sup Yoon
• Journal: Surgery today (Surg Today) Vol. 51 Issue 11 Pg. 1775-1786 (Nov 2021) ISSN: 1436-2813 [Electronic] Japan
• PMID: 33830293 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2021. Springer Nature Singapore Pte Ltd.

Topics

• Aged
• Chemotherapy, Adjuvant
• Disease-Free Survival
• Female
• Humans
• Kaplan-Meier Estimate
• Lymph Node Excision
• Lymphatic Metastasis (pathology)
• Male
• Margins of Excision
• Middle Aged
• Multicenter Studies as Topic
• Pancreas (surgery)
• Pancreatectomy (methods)
• Pancreatic Neoplasms (drug therapy, mortality, pathology, surgery)
• Propensity Score
• Retrospective Studies
• Splenectomy (methods)
• Treatment Outcome