Single institution results of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of pancreas in 78 patients

Grossman, Julie G.; Fields, Ryan C.; Hawkins, William G.; Strasberg, Steven M.

doi:10.1002/jhbp.362

Cited by 39 publications

(28 citation statements)

References 30 publications

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“…In this meta-analysis, we found that the R0 resection rate was significantly higher in the RAMPS group than in the standard surgery group [89.5% vs 83.6%, OR 95% CI, 2.19 (1.16 ~ 4.13); P = 0.02]. However, the combined resection rates were comparable between the RAMPS and standard groups [OR 95% CI, 3.30 (1.00 ~ 10.93); P = 0.05], which might be attributable to the low rate of posterior RAMPS procedures in present practices [24, 31, 32]. …”

Section: Discussionmentioning

confidence: 95%

Radical antegrade modular pancreatosplenectomy versus standard procedure in the treatment of left-sided pancreatic cancer: A systemic review and meta-analysis

Cao

et al. 2017

BMC Surg

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BackgroundRadical antegrade modular pancreatosplenectomy (RAMPS), first reported by Strasberg in 2003, has attracted increasing attention in the treatment of left-sided pancreatic cancer. The limited number of cases eligible for RAMPS makes it difficult to perform any prospective randomized trial of RAMPS versus the standard procedure. Therefore, we performed this systemic review and meta-analysis of the current data to clarify the role of the RAMPS procedure.MethodsA literature search was performed in electronic databases, including PubMed, Medline, Embase, CNKI and the Cochrane Library. Studies comparing RAMPS with the standard procedure were included in this meta-analysis. R0 resection rate, recurrence rate at the end of the follow-up, overall survival (OS) and disease-free survival (DFS) were measured as primary outcomes. Revman 5.3 was used to perform the analysis.ResultsSix retrospective cohort studies with a total number of 378 patients were included in our analysis. Meta-analysis revealed that RAMPS was correlated with higher R0 resection rates [Odds Ratio (OR) 95% confidence interval (CI), 2.19 (1.16 ~ 4.13); P = 0.02] and successful harvest of more lymph nodes [weighted mean difference (WMD) 95% CI, 7.06 (4.52 ~ 9.60); P < 0.01] compared with the standard procedure. However, no statistically significant difference was found between the procedures with respect to recurrence rates [OR 95% CI, 0.66 (0.40 ~ 1.09); P = 0.10], OS [Hazard ratio (HR) 95% CI, 0.65 (0.42 ~ 1.00); P = 0.05] or DFS [HR 95% CI, 1.02 (0.62 ~ 1.68); P = 0.93].ConclusionsRAMPS is safe and oncologically superior to the standard procedure for the treatment of left-sided pancreatic cancer. However, high-grade evidence will be necessary to confirm the potential survival benefits of RAMPS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-017-0259-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 95%

Radical antegrade modular pancreatosplenectomy versus standard procedure in the treatment of left-sided pancreatic cancer: A systemic review and meta-analysis

Cao

et al. 2017

BMC Surg

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“…It is difficult to evaluate RAMPS in terms of recurrence and overall survival due to high systemic recurrence rates that reach as high as 80% in some studies (2). Advanced local resection techniques cannot elevate five-yearoverall survival.…”

Section: Discussionmentioning

confidence: 99%

“…Until 2003 the preferred approach for this type of lesions was the standard retrograde pancreatosplenectomy (SRPS). Strasberg et al (1) in 2003 were the first who described the Radical Antegrade Modular Pancreatosplenectomy (RAMPS) in order to standardize the way pancreatic tumors of the body and tail should be surgically approached (1,2). It is built based on N1 lymph node dissection, after O'Morchoe's (3) description and classification of the pancreatic lymphatic drainage.…”

Section: Introductionmentioning

confidence: 99%

“…This procedure improves the surgical goals of radical oncological surgery by decreasing the number of positive resection margins and increasing the lymph node retrieval rates, performing a right-to-left pancreato-splenectomy with celiac node dissection and two plane posterior dissection associated with early vascular control and pancreatic neck transection (1,2). RAMPS also offers better visualization of the posterior dissection plane, thus decreasing the number o positive circumferential margins (retropancreatic negative margins).…”

Section: Introductionmentioning

confidence: 99%

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Is Radical Antegrade Modular Pancreatosplenectomy the Solution? A Systematic Literature Review and Meta-Analysis

Dragomir¹,

Eftimie²

2017

chr

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RezumatFond: RAMPS este considerată, în centrele cu volum chirurgical mare, ca fiind cea mai bună tehnică pentru tratamentul cancerelor corpului şi cozii de pancreas. Metodă: Baza de date PubMed a fost chestionată. Rezultatele studiilor ce compară RAMPS (Radical Antegrade Modular Pancreatosplenectomy) cu SRPS (Standard Retrograde Pancreatosplenectomy) au fost analizate prin metode de studiu meta-analitic. Rezultate: cinci studii publicate între 2013 şi 2016 au fost acceptate pentru studiu. 285 de pacienţi unici au fost incluşi, 135 de pacienţi în grupul RAMPS şi 150 în grupul SRPS. În ceea ce priveşte numărul de ganglioni limfatici rezecaţi, diferenţa medie a fost de 6,54. Această diferenţă a fost considerată ca fiind semnificativă din punct de vedere statistic, p < 0.00001. Rezecţia completă a fost obţinută la 115 din cei 129 de pacienţi operaţi prin tehnica RAMPS spre deosebire de 107 cazuri din 137 în cazul celor operaţi prin tehnica SRPS, RR fiind de 1,17 (95% CI; 1,04; 1,32). Supravieţuirea la un an a fost de 79,2% în grupul RAMPS, comparativ cu 64,29% în grupul SRPS. Această diferenţă este considerată semnificativă din punct de vedere statistic cu o valoare a p de 0,02. Concluzii: RAMPS este o procedură sigură pentru tratamentul chirurgical al adenocarcinoamelor corpului şi cozii de pancreas. RAMPS este superioară din punct de vedere al numărului ganglionilor rezecaţi şi al numărului rezecţiilor R0.Chirurgia (2017) Regarding retrieved lymph nodes, the mean difference was 6.54. This difference was considered to be statistical significant, P < 0.00001. A complete tumor resection was observed in 115 of 129 patients who underwent RAMPS and in the case of the standard procedure a R0 resection was obtained in 107 cases out of 137, the RR was 1.17 (95% CI, 1.04, 1.32). One-year overall survival was found to be 79.2% in the RAMPS groups compared with 64.29% in the SRPS group. This difference is considered statistically significant, with a P value of 0.02. Conclusions: RAMPS is a safe procedure for the treatment of adenocarcinomas of the body and tail of the pancreas. RAMPS procedure is superior to SRPS in terms of lymph node retrieval and R0 resections.

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“…After discussion at our multidisciplinary tumor conference, she was taken for radical antegrade modular pancreatosplenectomy in April 2015 [16, 17]. Initially, a diagnostic laparoscopy was performed, which did not demonstrate evidence of disseminated or peritoneal metastasis.…”

Section: Case Reportmentioning

confidence: 99%

Complete Response after Treatment with Neoadjuvant Chemoradiation with Prolonged Chemotherapy for Locally Advanced, Unresectable Adenocarcinoma of the Pancreas

Pompa

Morano

Jeurkar

et al. 2017

Case Reports in Oncological Medicine

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Surgery is the only chance for cure in pancreatic ductal adenocarcinoma. In unresectable, locally advanced pancreatic cancer (LAPC), the National Comprehensive Cancer Network (NCCN) suggests chemotherapy and consideration for radiation in cases of unresectable LAPC. Here we present a rare case of unresectable LAPC with a complete histopathological response after chemoradiation followed by surgical resection. A 54-year-old female presented to our clinic in December 2013 with complaints of abdominal pain and 30-pound weight loss. An MRI demonstrated a mass in the pancreatic body measuring 6.2 × 3.2 cm; biopsy revealed proven ductal adenocarcinoma. Due to splenic vein/artery and contiguous celiac artery encasement, she was deemed surgically unresectable. She was started on FOLFIRINOX therapy (three cycles), intensity modulated radiation to a dose of 54 Gy in 30 fractions concurrent with capecitabine, followed by FOLFIRI, and finally XELIRI. After 8 cycles of ongoing XELIRI completed in March 2015, restaging showed a remarkable decrease in tumor size, along with PET-CT revealing no FDG-avid uptake. She was reevaluated by surgery and taken for definitive resection. Histopathological evaluation demonstrated a complete R0 resection and no residual tumor. Based on this patient and literature review, this strategy demonstrates potential efficacy of neoadjuvant chemoradiation with prolonged chemotherapy, followed by surgery, which may improve outcomes in patients deemed previously unresectable.

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Single institution results of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of pancreas in 78 patients

Abstract: The RAMPS technique resulted in high negative tangential margin rates and good lymph node retrieval. The long-term survival result in 78 patients is probably an accurate reflection of what is possible with this tumor using this technique at this time.

Cited by 39 publications

References 30 publications

Radical antegrade modular pancreatosplenectomy versus standard procedure in the treatment of left-sided pancreatic cancer: A systemic review and meta-analysis

Radical antegrade modular pancreatosplenectomy versus standard procedure in the treatment of left-sided pancreatic cancer: A systemic review and meta-analysis

Is Radical Antegrade Modular Pancreatosplenectomy the Solution? A Systematic Literature Review and Meta-Analysis

Complete Response after Treatment with Neoadjuvant Chemoradiation with Prolonged Chemotherapy for Locally Advanced, Unresectable Adenocarcinoma of the Pancreas

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