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Radical antegrade modular pancreatosplenectomy (RAMPS) versus conventional distal pancreatosplenectomy (CDPS) for left-sided pancreatic ductal adenocarcinoma

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Abstract

Purpose

The insufficient clearance of regional lymph nodes and unsatisfactory R0 resection rate may result in the metastasis of left-sided pancreatic ductal adenocarcinoma (PDAC) after conventional distal pancreatosplenectomy (CDPS). Radical antegrade modular pancreatosplenectomy (RAMPS) was designed to achieve R0 resection more successfully with better lymph-node clearance; however, there is still insufficient evidence of its short- and long-term results to confirm its superiority. We conducted this study to compare the efficiency of these two procedures.

Methods

The subjects of this retrospective analysis were 103 patients with left-sided PDAC who underwent either RAMPS (n = 46) or CDPS (n = 57). We assessed perioperative data and surgical information and used univariate and multivariate analyses to identify prognostic factors for survival.

Results

There were no significant differences in baseline data between the groups. RAMPS was associated with a significantly shorter hospital stay (12.11 days vs. 22.98 days; P < 0.001), and significantly less blood loss (451.09 ml vs. 764.04 ml, P = 0.002), as well as a significantly lower rate of blood transfusion (15.22% vs. 33.33%, P = 0.035). RAMPS and CDPS had comparable perioperative complication rates. Moreover, RAMPS achieved more effective lymph-node retrieval (17.87 vs. 10.23; P < 0.001). The RAMPS group had a higher overall survival (OS) rate (28.73 months vs. 18.30 months; P = 0.003) and a higher disease-free survival (DFS) rate (21.97 months vs. 9.40 months; P < 0.001).

Conclusion

RAMPS achieved better survival and surgical outcomes than CDPS for patients with left-sided PDAC.

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Funding

This work was supported by the Project of Capital Health Research and Development of Special (No. 2020-1-4011), Beijing, China.

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Author notes

  1. Menghua Dai and Hanyu Zhang have contributed equally to this article.

Authors and Affiliations

  1. Department of General Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Menghua Dai, Hanyu Zhang, Yatong Li, Cheng Xing, Cheng Ding, Quan Liao, Taiping Zhang, Junchao Guo, Qiang Xu, Xianlin Han, Wenjing Liu & Qiaofei Liu

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  1. Menghua Dai
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  2. Hanyu Zhang
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Correspondence to Menghua Dai.

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This study was reviewed and approved by the Institutional Review Board (IRB) of Peking Union Medical College Hospital (No. S-k846).

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Dai, M., Zhang, H., Li, Y. et al. Radical antegrade modular pancreatosplenectomy (RAMPS) versus conventional distal pancreatosplenectomy (CDPS) for left-sided pancreatic ductal adenocarcinoma. Surg Today 51, 1126–1134 (2021). https://doi.org/10.1007/s00595-020-02203-3

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  • DOI: https://doi.org/10.1007/s00595-020-02203-3

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