Masillamany Sivasanker1, Ashwin Desouza2, Manish Bhandare2, Vikram Chaudhari2, Mahesh Goel2, Shailesh V Shrikhande3,4. 1. Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. 2. Department of Gastrointestinal and HPB Surgery, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400012, India. 3. Department of Gastrointestinal and HPB Surgery, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400012, India. shailushrikhande@hotmail.com. 4. Division of Cancer Surgery, Department of Gastrointestinal and HPB Surgery, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400012, India. shailushrikhande@hotmail.com.
Abstract
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.
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.
Authors: Milena Muzzolini; Raphael L C Araujo; T Peter Kingham; Frédérique Peschaud; François Paye; Renato M Lupinacci Journal: Eur J Surg Oncol Date: 2021-12-03 Impact factor: 4.424
Authors: Thomas L Sutton; Kristin C Potter; Skye C Mayo; Rodney Pommier; Erin W Gilbert; Brett C Sheppard Journal: World J Surg Date: 2022-04-11 Impact factor: 3.282