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

• Published in: Langenbeck's archives of surgery Vol. 404; no. 2; pp. 183 - 190
• Main Authors: Sivasanker, Masillamany, Desouza, Ashwin, Bhandare, Manish, Chaudhari, Vikram, Goel, Mahesh, Shrikhande, Shailesh V.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2019
• Subjects: Abdominal Surgery; Academic Medical Centers; Age Factors; Aged; Cardiac Surgery; Combined Modality Therapy; Databases, Factual; Disease-Free Survival; Female; General Surgery; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness - pathology; Neoplasm Staging; Original Article; Pancreatectomy - methods; Pancreatic Neoplasms; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Prognosis; Retrospective Studies; Risk Assessment; Sex Factors; Splenectomy - methods; Survival Analysis; Thoracic Surgery; Traumatic Surgery; Treatment Outcome; Vascular Surgery; Distal pancreatosplenectomy; Radical antegrade modular pancreatosplenectomy; Pancreatic tumors
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-019-01763-4

Background Radical antegrade modular pancreatosplenectomy (RAMPS) has been propagated as the standard of care for pancreatic cancers involving the body and tail of the pancreas. This procedure has been shown to have promising results in enhancing the microscopically negative tangential resection margins as well as the lymph node yield. Methods This is a retrospective analysis of prospectively maintained database on the resections performed for all pancreatic body and tail tumors at Tata Memorial Centre. Results Sixty-five patients underwent RAMPS without any perioperative mortality. The various pathologies comprised of adenocarcinoma (41.5%), neuroendocrine tumors (12.3%), solid pseudopapillary epithelial neoplasm (15.3%), cystic neoplasms (15.2%), etc. The R0 resection rate was 87.7%. Among this cohort, 27 patients had pancreatic adenocarcinoma. The 3-year OS and DFS for distal pancreatic cancers were 56% and 38%, respectively, but 3-year OS and DFS for other distal pancreatic tumors were 97% and 73%, respectively. On multivariate analysis, R0 resection significantly improved disease-free survival ( p  = 0.023) for pancreatic cancer. Conclusion RAMPS procedure aids to achieve high negative tangential margins for all tumors involving the body and tail of the pancreas and not just pancreatic cancer in isolation. Since preoperative histologic diagnosis is not routinely indicated and also a number of other distal pancreatic tumors carry a relatively better prognosis compared with pancreatic cancer, our results provide further evidence that RAMPS should be considered as the procedure of choice for all operable tumors involving body and tail of the pancreas.