Radical antegrade modular pancreatosplenectomy for all pancreatic body and tail tumors: rationale and results

Sivasanker, Masillamany; Desouza, Ashwin; Bhandare, Manish; Chaudhari, Vikram; Goel, Mahesh; Shrikhande, Shailesh V.

doi:10.1007/s00423-019-01763-4

Cited by 17 publications

(9 citation statements)

References 31 publications

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“…With the exception of pancreatic cancer, radical antegrade modular pancreatosplenectomy has produced better oncological results for all pancreatic tumours. Therefore, when there is no availability of pre-operative histological diagnosis, RAMPS could be recommended for all operative tumours that involve the pancreatic tail and body [46].…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic distal pancreatectomy for benign and malignant disease: a review of techniques and results

Coco¹,

Leanza²,

Schillaci³

et al. 2022

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Diagnosis of pancreatic cancer is challenging in the initial phases because its progression is rapid. The pancreatic tail and body roughly accounts for 20-30% of all cancerous cases. The standard treatment for symptomatic benign, malignant, and premalignant diseases of the pancreatic tail and body is distal pancreatectomy. This technique has been modified over the years to fit certain indications, with the goal of enhancing post-operative results as well as reducing patient trauma. In cases of a premalignant and symptomatic benign condition, the spleen must be preserved either using Kimura's splenic vessel preservation technique or Warshaw's splenic vessel resection technique. A better long-term prognosis is ensured by regional lymph node dissection and radical R0 resection. Radical antegrade modular pancreatosplenectomy was proposed to tackle the shortcomings of traditional surgery for pancreatic tail and body cancer. In this review, study techniques and results of laparoscopic distal pancreatectomy for malignant and benign pancreatic ailments were described with the intention of providing knowledge on various suitable techniques reported for pancreatic cancer treatment. Furthermore, this study will serve as a ready reckoner for surgeons and could serve to boost their confidence levels during surgery by avoiding confusion on the selection of suitable for the pancreatic diseases diagnosed.

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Section: Resultsmentioning

confidence: 99%

Laparoscopic distal pancreatectomy for benign and malignant disease: a review of techniques and results

Coco¹,

Leanza²,

Schillaci³

et al. 2022

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“…Second, the different surgical procedures for PHC and PBTC may have contributed to the difference in overall survival rates. The radical antegrade modular pancreatosplenectomy (RAMPS) procedure, which is the standard operation method for PBTC, helps to achieve negative tangential margins for tumors [31]. Distal pancreatectomy, which does not require anastomosis after resection, is recognized as a safe alternative to open surgery for benign and low-malignancy tumors because laparoscopy was faster than pancreaticoduodenectomy [32,33].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Characteristics and Survival Rates of Resectable Pancreatic Ductal Adenocarcinoma according to Tumor Location

et al. 2021

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The impact of tumor location on patient survival in pancreatic ductal adenocarcinoma (PDAC) remains controversial. This study investigated the association between primary tumor location and survival rates for resectable PDAC. Additionally, we assessed if this association remains consistent across categories of the Tumor-Node-Metastasis staging system. We analyzed 2471 patients who underwent surgical resection between 2000 and 2018 at a single center. Subgroup analysis was performed according to the Tumor-Node-Metastasis staging system. Among the group, 67.9% (1677 patients) had pancreatic head cancer (PHC) and 32.1% (794 patients) had pancreatic body/tail cancer (PBTC). Patients with PHC had worse overall survival and worse disease-free survival than those with PBTC. Patients with PHC had worse survival in stage IB and stage IIB than those with PBTC. No significant difference was observed for stages IA, IIA, and III. Multivariate analysis showed that elevated CA 19-9, mGPS, a longer hospital stay, complication, accompanying vein resection, larger tumor size, worse differentiation, higher TNM stage (stage IIB, III, IV), presence of LVI, and positive resection margin were risk factors for poor survival after resection. In resectable PDAC, patients with PHC had worse overall and disease-free survival than those with PBTC. However, tumor location was not an independent prognostic factor for PDAC.

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“…The procedure was named "RAMPS," and at present, it is performed extensively worldwide as the primary procedure for advanced cancer of the pancreatic body and tail. [23][24][25][26] RAMPS and our proposed DP-TCR procedure aim to achieve histologically radical surgery. Both procedures have the same philosophy in that they attempt to resect the retroperitoneum en bloc with the pancreatic body and tail and the spleen.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Advanced Pancreatic Body and Tail Cancer by En Bloc Distal Pancreatectomy with Transverse Mesocolon Resection Using a Mesenteric Approach

et al. 2021

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BackgroundPancreatic body and tail cancer easily invades the retroperitoneal tissue, including the transverse mesocolon. It is difficult to ensure a dissected peripancreatic margin using standard distal pancreatectomy for advanced pancreatic body and tail cancer.Thus, we developed a novel surgical procedure to ensure dissection of the peripancreatic margin. This involved performing dissection deeper than the fusion fascia of Toldt and further extensive en bloc resection of the root of the transverse mesocolon. We performed distal pancreatectomy with transverse mesocolon resection (DP-TCR) using the mesenteric approach and achieved good outcomes. MethodsThere are two main considerations regarding the surgical procedure using the mesenteric approach: 1) dissection deeper than the fusion fascia of Toldt (securing the vertical margin) and 2) modular resection of the pancreatic body and tail, with the root of the transverse mesocolon and adjacent organs in a horizontal direction (ensuring the caudal margin).

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Radical antegrade modular pancreatosplenectomy for all pancreatic body and tail tumors: rationale and results

Cited by 17 publications

References 31 publications

Laparoscopic distal pancreatectomy for benign and malignant disease: a review of techniques and results

Laparoscopic distal pancreatectomy for benign and malignant disease: a review of techniques and results

Comparison of Characteristics and Survival Rates of Resectable Pancreatic Ductal Adenocarcinoma according to Tumor Location

Treatment of Advanced Pancreatic Body and Tail Cancer by En Bloc Distal Pancreatectomy with Transverse Mesocolon Resection Using a Mesenteric Approach

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