Edoardo Rosso1, Sébastien Frey2,3, Giuseppe Zimmitti4, Alberto Manzoni4, Marco Garatti4, Antonio Iannelli2,3,5. 1. Department of Surgery, Instituto Fondazione Poliambulanza, via Bissolati n°57, 25124, Brescia, Italy. edoardo_rosso@hotmail.com. 2. Université Côte d'Azur, Nice, France. 3. Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Archet 2 Hospital, Nice, France. 4. Department of Surgery, Instituto Fondazione Poliambulanza, via Bissolati n°57, 25124, Brescia, Italy. 5. Inserm U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", Nice, France.
Abstract
BACKGROUND: Laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) with vascular resection for pancreatic cancer has been rarely reported in the literature. Several critical steps are required to achieve a safe radical resection under laparoscopy while respecting oncologic principles of radicality. METHODS: Prospectively collected data on a consecutive series of patients undergoing radical antegrade modular pancreatosplenectomy (RAMPS) were retrospectively reviewed for the purpose of this study. Patients were divided into two groups based on the surgical approach and the need for vascular resection, and data were compared. The surgical technique is reported in detail focusing on the different modalities of vascular resection. RESULTS: Twenty-three patients (male/female ratio, 12/11; mean age, 73 years) underwent RAMPS between July 2014 and October 2018 at our institution. Of these, 17 had a laparoscopic approach and six a standard open approach. All patients in the open group underwent complex vascular reconstructions while four out of 17 (23.5%) underwent laparoscopic vascular resection. One patient in the laparoscopic approach required a vascular reconstruction with graft interposition, which combined the two approaches. There was no mortality, and the complication rate and the duration of surgery were comparable between the two groups. CONCLUSION: L-RAMPS with vascular resection is feasible and safe in selected cases when performed by advanced pancreatic surgeons with experience in laparoscopic surgery.
BACKGROUND: Laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) with vascular resection for pancreatic cancer has been rarely reported in the literature. Several critical steps are required to achieve a safe radical resection under laparoscopy while respecting oncologic principles of radicality. METHODS: Prospectively collected data on a consecutive series of patients undergoing radical antegrade modular pancreatosplenectomy (RAMPS) were retrospectively reviewed for the purpose of this study. Patients were divided into two groups based on the surgical approach and the need for vascular resection, and data were compared. The surgical technique is reported in detail focusing on the different modalities of vascular resection. RESULTS: Twenty-three patients (male/female ratio, 12/11; mean age, 73 years) underwent RAMPS between July 2014 and October 2018 at our institution. Of these, 17 had a laparoscopic approach and six a standard open approach. All patients in the open group underwent complex vascular reconstructions while four out of 17 (23.5%) underwent laparoscopic vascular resection. One patient in the laparoscopic approach required a vascular reconstruction with graft interposition, which combined the two approaches. There was no mortality, and the complication rate and the duration of surgery were comparable between the two groups. CONCLUSION: L-RAMPS with vascular resection is feasible and safe in selected cases when performed by advanced pancreatic surgeons with experience in laparoscopic surgery.
Authors: Giuseppe Zimmitti; Roberta La Mendola; Alberto Manzoni; Valentina Sega; Valentina Malerba; Elio Treppiedi; Claudio Codignola; Lorenzo Monfardini; Marco Garatti; Edoardo Rosso Journal: Surg Endosc Date: 2020-09-10 Impact factor: 4.584