Laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer using the ligament of Treitz approach

Ome, Yusuke; Hashida, Kazuki; Yokota, Mitsuru; Nagahisa, Yoshio; Okabe, Masaru; Kawamoto, Kazuyuki

doi:10.1007/s00464-017-5561-6

Cited by 36 publications

(44 citation statements)

References 13 publications

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“…This study clari ed that LRAMPS is technically safe and feasible procedure in well-selected patients with PC in the distal pancreas. [19].Our series with 10 cases showed a morbidity rate of 50.0%, and the PF rate of 30.0%, similar to what have been reported in the literature [5][6][7][8][9][10][11].Even the operation more complicated, the LRAMPS didn't increase the risk of complications but with the advantages related to minimal-access surgery, such as less intraoperative blood loss, faster recovery. [19].…”

Section: Discussionsupporting

confidence: 85%

“…[19]. Our series with 10 cases showed a count of retrieved lymph nodes of 15 (range, [13][14][15][16][17][18][19][20][21],and the R0 resection rate of 100.0%, similar to what have been reported in the literature [5][6][7][8][9][10][11].So whether LRAMPS could achieve better oncological outcomes than laparoscopic conventional DPS or similar oncological outcomes as open RAMPS need more randomized controlled test to con rm. No study to date has shown improved overall survival between RAMPS and standard DP [21][22][23].…”

Section: Discussionsupporting

confidence: 80%

“…Kang et al [24]and Lee et al [6] considered that it would be wise to limit the LRAMPS procedure to anterior RMAPS alone. The indication proposed by Ome et al [8] for LRAMPS is left-sided PC located ≥ 1 cm away from the origin of the SA without invasion of the SMA, CA, CHA, or PV. Kim et al [7] performed LRAMPS for the left-sided PC that was less than stage T3 without distant metastasis or unable to secure a safety margin from a major vessel, such as the SMA or PV or CA.…”

Section: Discussionmentioning

confidence: 99%

“…Kim et al [7] performed LRAMPS for the left-sided PC that was less than stage T3 without distant metastasis or unable to secure a safety margin from a major vessel, such as the SMA or PV or CA. But from the literature review [5][6][7][8][9][10][11],more patients underwent posterior RAMPS even with combined resection of the transverse colon with the safe and effective outcomes. With the technical evolution and clinical experience accumulating, the indication of LRAMPS will be expanded.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Radical Antegrade Modular Pancreatosplenectomy: Preliminary Experience with 10 Cases

Zhang

Gan²,

Song³

et al. 2020

Preprint

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BackgroundThe 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.MethodsFrom 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.ResultsLRAMPS was performed successfully in all the patients. The median operative time was 235 minutes (range, 212–270 min), with an EBL of 120 ml(range,100–200 ml). 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, 3–14 m). 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.ConclusionsLRAMPS 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.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Radical Antegrade Modular Pancreatosplenectomy: Preliminary Experience with 10 Cases

Zhang

Gan²,

Song³

et al. 2020

Preprint

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“…This procedure was adopted by minimally invasive pancreatic surgeons, which perform laparoscopic or robotic RAMPS, with great preliminary results (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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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International Expert Consensus on Precision Anatomy for minimally invasive distal pancreatectomy: PAM‐HBP Surgery Project

Ban

Nishino

Ohtsuka

et al. 2021

J Hepato Biliary Pancreat

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Background Surgical views with high resolution and magnification have enabled us to recognize the precise anatomical structures that can be used as landmarks during minimally invasive distal pancreatectomy (MIDP). This study aimed to validate the usefulness of anatomy‐based approaches for MIDP before and during the Expert Consensus Meeting: Precision Anatomy for Minimally Invasive HBP Surgery (February 24, 2021). Methods Twenty‐five international MIDP experts developed clinical questions regarding surgical anatomy and approaches for MIDP. Studies identified via a comprehensive literature search were classified using Scottish Intercollegiate Guidelines Network methodology. Online Delphi voting was conducted after experts had drafted the recommendations, with the goal of obtaining >75% consensus. Experts discussed the revised recommendations in front of the validation committee and an international audience of 384 attendees. Finalized recommendations were made after a second round of online Delphi voting. Results Four clinical questions were addressed, resulting in 10 recommendations. All recommendations reached at least a 75% consensus among experts. Conclusions The expert consensus on precision anatomy for MIDP has been presented as a set of recommendations based on available evidence and expert opinions. These recommendations should guide experts and trainees in performing safe MIDP and foster its appropriate dissemination worldwide.

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Laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer using the ligament of Treitz approach

Abstract: Lap-RAMPS using the ligament of Treitz approach is feasible and extremely helpful in performing minimally invasive, curative resection for well-selected left-sided PC.

Cited by 36 publications

References 13 publications

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy: Preliminary Experience with 10 Cases

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy: Preliminary Experience with 10 Cases

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

International Expert Consensus on Precision Anatomy for minimally invasive distal pancreatectomy: PAM‐HBP Surgery Project

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