Comparison of Standard Distal Pancreatectomy and Splenectomy with Radical Antegrade Modular Pancreatosplenectomy

Abstract

Radical antegrade modular pancreatosplenectomy (RAMPS) has been reported to provide improved margin resection and lymph node retrieval for tumors of the body and tail of the pancreas compared with standard resection. We examined our experience with RAMPS and standard resection to determine differences in clinicopathologic outcomes. A comparison of RAMPS procedures was made to standard distal pancreatectomy and splenectomy examining various clinicopathologic variables through retrospective chart review. Twenty-six patients underwent distal pancreatectomy with or without splenectomy between November 2004 and June 2011. Twenty patients underwent standard resection and six patients underwent RAMPS procedures for a variety of histologies. As a result of the heterogeneity of diseases, which included benign lesions, margin status was not applicable in some cases and therefore was not assessed overall. Fisher's exact test and Wilcoxon rank sum tests demonstrated a significant difference in number of lymph nodes removed with mean of 4.3 and 11.2 lymph nodes obtained for standard resection and RAMPS, respectively ( P = 0.03). The RAMPS procedure for lesions of the body and tail of the pancreas retrieved significantly more lymph nodes than standard distal pancreatectomy and splenectomy. It should be the preferred surgical approach when lymph node count is important for tumor staging.

A systematic review of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas

“…There are many differences between the studies in terms of the patient selection, disease stage, surgical skill, and perioperative care. The definition of R0 resection was inhomogeneous; 12 studies simply reported that 'surgical margins' were negative without specified criteria, [4][5][6]14,[16][17][18] whereas others referred to the 'absence of microscopic tumor cells' 7,10 or 'the tumor is >1 mm from all inked margins' . 15,19 Meta-analysis of observational studies may either exaggerate or underestimate the magnitude of measured effect.…”

“…1, the literature search initially yielded 41 articles, of which 13 studies comprising a total of 354 patients fulfilling the eligibility criteria were included in this systematic review and are summarized in Table 1. 4-10, [14][15][16][17][18][19] Agreement for these studies was 100% between the two reviewers. No randomised controlled trials (RCT) or meta-analyses were identified.…”

“…Meta-analysis of RAMPS vs. SRPS Four studies compared RAMPS (n = 105) with SRPS (n = 131). 6,10,14,18 Table 3 summarizes the outcomes of the metaanalysis. Compared with the SRPS group, the RAMPS group exhibited less intraoperative bleeding, a greater number of total retrieved lymph nodes, and a higher percentage of R0 resection ( Fig.…”

The short- and long-term outcomes of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas

“…A second possibility is that different numbers of lymph nodes were harvested in the RAMPS and standard DP procedures. Trottman et al [ 16 ] examined 26 cases in which RAMPS and standard resection was performed to identify differences in the clinicopathological outcomes of the patients. They demonstrated a significant difference in the mean number of lymph nodes that were removed in standard resection (4.3) and RAMPS (11.2) ( P = 0.03).…”

Normal Postoperative Computed Tomography Findings after a Variety of Pancreatic Surgeries

“…Recently, RAMPS is suggested for ability to properly visualize the posterior plane of dissection and superior N1 lymph node complete dissection to traditional distal pancreatectomy ( Fig. 6A ) ( 2 21 22 ). It also provides the option for selection of an oncologically appropriate posterior margin depending on the tumor extent ( 2 ).…”