Laparoscopic Radical Antegrade Modular Pancreatosplenectomy: Preliminary Experience with 10 Cases

Abstract

Background: The radical antegrade modular pancreatosplenectomy (RAMPS) which is a reasonable surgical approach for left-sided pancreatic cancer is emphasis on the complete resection of regional lymph nodes and tumor-free margin resection. Laparoscopic radical antegrade modular pancreatosplenectomy(LRAMPS) has been rarely performed, with only 49 cases indexed on PubMed. In this study, we present our experience of LRAMPS. Methods: From December 2018 to February 2020, 10 patients underwent LRAMPS for pancreatic cancer at our department. The data of the patient demographics, intraoperative variables , postoperative hospital stay, morbidity, mortality, pathologic findings and follow-up were collected.Results: LRAMPS was performed successfully in all the patients. The median operative time was 235 minutes (range, 212-270min), with an EBL of 120ml(range,100-200ml) . Postoperative complications occurred in 5 (50.0%) patients. Three patients developed a grade B pancreatic fistula. There was no postoperative 30-day mortality and reoperation. The median postoperative hospital stay was 14 days(range,9- 24d).The median count of retrieved lymph nodes was 15 (range, 13–21), and four patients (40%) had malignant-positive lymph nodes. All cases achieved a negative tangential margin and R0 resection.Median follow-up time was 11 months (range, 3–14m). Two patients developed disease recurrence(pancreatic bed recurrence and liver metastasis) 9 months,10 months after surgery,respectively. Others survived without tumor recurrence or metastasis．Conclusions: LRAMPS is technically safe and feasible procedure in well-selected patients with pancreatic cancer in the distal pancreas. The oncologically outcomes need to be further validated based on additional large-volume studies.