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

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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.

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Acknowledgements

The authors would like to thank the Department of Gastrointestinal Surgery and Surgical Oncology, Tata Memorial Hospital, Mumbai, India.

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Authors and Affiliations

  1. Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

    Masillamany Sivasanker

  2. Department of Gastrointestinal and HPB Surgery, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400012, India

    Ashwin Desouza, Manish Bhandare, Vikram Chaudhari, Mahesh Goel & Shailesh V. Shrikhande

  3. Division of Cancer Surgery, Department of Gastrointestinal and HPB Surgery, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400012, India

    Shailesh V. Shrikhande

Authors
  1. Masillamany Sivasanker
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  2. Ashwin Desouza
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  3. Manish Bhandare
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  4. Vikram Chaudhari
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  5. Mahesh Goel
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  6. Shailesh V. Shrikhande
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Contributions

Study concept and design: MS, MG, and SVS. Acquisition of data: MS, AD, MB, and VC. Analysis and interpretation of data: MS, VC, and SVS. Drafting of the manuscript: MS and SVS. Critical revision of the manuscript for important intellectual content: VC and SVS.

Corresponding author

Correspondence to Shailesh V. Shrikhande.

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The authors declare that they have no conflict of interest.

Ethical approval

The data of the present study were collected in the course of common clinical practice and accordingly, the signed informed consent was obtained from each patient for any clinical procedure as well as for clinical data procurement. The study protocol was in accordance with ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments. Since this was a retrospective study, formal consent for this study is not required and no approval of the institutional research committee was needed.

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Sivasanker, M., Desouza, A., Bhandare, M. et al. Radical antegrade modular pancreatosplenectomy for all pancreatic body and tail tumors: rationale and results. Langenbecks Arch Surg 404, 183–190 (2019). https://doi.org/10.1007/s00423-019-01763-4

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  • DOI: https://doi.org/10.1007/s00423-019-01763-4

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