Preliminary experience of radical antegrade modular pancreatosplenectomy for pancreatic body and tail cancer: report of 52 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

QIN Shuangli , CHENG Kun ,  HAN Wei , CHEN Qilong , LIN Hai , HE Tieying , XU Xinjian

Department of Pancreatic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumchi 830054, P. R. China;

Corresponding author：

HAN Wei, Email: 13999846637@139.com

Keywords：

pancreatic body and tail cancer; radical antegrade modular pancreatosplenectomy; prognosis

DOI：

10.7507/1007-9424.201711052

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the experience of single center for radical antegrade modular pancreatosplenectomy (RAMPS) in the treatment of pancreatic body and tail cancer. Methods The clinical data of 52 patients with pancreatic body and tail cancer who underwent RAMPS surgery in the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2016 were retrospectively analyzed. Results All operations of the 52 patients were successfully completed, with no death during hospitalization and 30 days after surgery. The operative time was (463±137) min (198–830 min), the median of intraoperative blood loss was 400 mL (100–2 800 mL), of which 19 cases (36.5%) received intraoperative blood transfusion. The median of hospital stay was 19.5 days (7–58 days). After operation, 18 patients suffered from pancreatic fistula, 5 patients suffered from delay gastric emptying, 7 patients suffered from peritoneal effusion, 3 patients suffered from pleural effusion, 4 patients suffered from abdominal infection, 2 patients suffered from abdominal bleeding. Reoperations were performed in 2 patients. There were 51 patients were followed up for 3–35 months (the median of 18 months) with the median survival time were 16.2 months. During the follow-up period, 21 patients suffered from recurrence or metastasis, of which 8 patients died. The results of Cox partial hazard model showed that, surgical margin ［RR=3.65, 95% CI was (0.06, 5.11), P=0.026］ and adjuvant therapy ［RR=6.43, 95% CI was (1.51, 27.43), P=0.012］ were statistically related with prognosis, the prognosis of patients with negative surgical margin and underwent adjuvant therapy were better than those patients with positive surgical margin and didn’t underwent adjuvant therapy. Conclusions RAMPS is safe and feasible in the treatment of pancreatic body and tail cancer, and it may improve the R0 resection rate. RAMPS combins with adjuvant therapy can contribute to better prognosis.

Citation： QIN Shuangli, CHENG Kun, HAN Wei, CHEN Qilong, LIN Hai, HE Tieying, XU Xinjian. Preliminary experience of radical antegrade modular pancreatosplenectomy for pancreatic body and tail cancer: report of 52 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(6): 673-679. doi: 10.7507/1007-9424.201711052 Copy

1.	Hidalgo M. Pancreatic cancer. N Engl J Med, 2010, 362(17): 1605-1617.
2.	Konstantinidis IT, Warshaw AL, Allen JN, et al. Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a " true” R0 resection? Ann Surg, 2013, 257(4): 731-736.
3.	Hartwig W, Hackert T, Hinz U, et al. Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg, 2011, 254(2): 311-319.
4.	刘续宝, 柯能文. 胰头癌根治性切除的几个问题. 中国普外基础与临床杂志, 2017, 24(6): 661-664.
5.	Fernández-del Castillo C, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg, 1995, 130(3): 295-299.
6.	Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery, 2003, 133(5): 521-527.
7.	Strasberg SM, Linehan DC, Hawkins WG. Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg, 2007, 204(2): 244-249.
8.	Mitchem JB, Hamilton N, Gao F, et al. Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg, 2012, 214(1): 46-52.
9.	Kitagawa H, Tajima H, Nakagawara H, et al. A modification of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the left pancreas: significance of en bloc resection including the anterior renal fascia. World J Surg, 2014, 38(9): 2448-2454.
10.	Chang YR, Han SS, Park SJ, et al. Surgical outcome of pancreatic cancer using radical antegrade modular pancreatosplenectomy procedure. World J Gastroenterol, 2012, 18(39): 5595-5600.
11.	Rosso E, Langella S, Addeo P, et al. A safe technique for radical antegrade modular pancreatosplenectomy with venous resection for pancreatic cancer. J Am Coll Surg, 2013, 217(5): e35-e39.
12.	徐冬, 蒋奎荣, 陆子鹏, 等. 根治性顺行模块化胰脾切除术治疗胰体尾癌的临床疗效. 中华消化外科杂志, 2016, 15(6): 567-573.
13.	Scoazec JY, Sabourin JC. 2010: the seventh edition of the TNM classification. Ann Pathol, 2010, 30(1): 2-6.
14.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
15.	Healy JM, Kunstman JW, Salem RR. Proposal and critical appraisal of exclusion criteria to the international study group for pancreatic surgery definition of delayed gastric emptying. J Am Coll Surg, 2015, 220(6): 1036-1043.
16.	Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
17.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
18.	Cao F, Li J, Li A, et al. Radical antegrade modular pancreatosplenectomy versus standard procedure in the treatment of left-sided pancreatic cancer: a systemic review and meta-analysis. BMC Surg, 2017, 17(1): 67.
19.	Zhou Y, Shi B, Wu L, et al. A systematic review of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. HPB (Oxford), 2017, 19(1): 10-15.
20.	Grossman JG, Fields RC, Hawkins WG, et al. Single institution results of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of pancreas in 78 patients. J Hepatobiliary Pancreat Sci, 2016, 23(7): 432-441.
21.	Lillemoe KD, Kaushal S, Cameron JL, et al. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg, 1999, 229(5): 693-698.
22.	Abe T, Ohuchida K, Miyasaka Y, et al. Comparison of Surgical Outcomes Between Radical Antegrade Modular Pancreatosplenectomy (RAMPS) and Standard Retrograde Pancreatosplenectomy (SPRS) for left-sided pancreatic cancer. World J Surg, 2016, 40(9): 2267-2275.
23.	Park HJ, You DD, Choi DW, et al. Role of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. World J Surg, 2014, 38(1): 186-193.
24.	Trottman P, Swett K, Shen P, et al. Comparison of standard distal pancreatectomy and splenectomy with radical antegrade modular pancreatosplenectomy. Am Surg, 2014, 80(3): 295-300.
25.	Latorre M, Ziparo V, Nigri G, et al. Standard retrograde pancreatosplenectomy versus radical antegrade modular pancreatosplenectomy for body and tail pancreatic adenocarcinoma. Am Surg, 2013, 79(11): 1154-1158.
26.	Kim EY, You YK, Kim DG, et al. Initial experience with radical antegrade modular pancreatosplenectomy in a single institution. Ann Surg Treat Res, 2016, 91(1): 29-36.
27.	Verbeke CS, Leitch D, Menon KV, et al. Redefining the R1 resection in pancreatic cancer. Br J Surg, 2006, 93(10): 1232-1237.
28.	Hsu CC, Herman JM, Corsini MM, et al. Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. Ann Surg Oncol, 2010, 17(4): 981-990.
29.	纪宗正, 张焱. 胰体尾癌的综合治疗. 中国普外基础与临床杂志, 2011, 18(1): 3-5.
30.	Miller RC, Iott MJ, Corsini MM. Review of adjuvant radiochemotherapy for resected pancreatic cancer and results from Mayo Clinic for the 5^th JUCTS symposium. Int J Radiat Oncol Biol Phys, 2009, 75(2): 364-368.

1. Hidalgo M. Pancreatic cancer. N Engl J Med, 2010, 362(17): 1605-1617.
2. Konstantinidis IT, Warshaw AL, Allen JN, et al. Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a " true” R0 resection? Ann Surg, 2013, 257(4): 731-736.
3. Hartwig W, Hackert T, Hinz U, et al. Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg, 2011, 254(2): 311-319.
4. 刘续宝, 柯能文. 胰头癌根治性切除的几个问题. 中国普外基础与临床杂志, 2017, 24(6): 661-664.
5. Fernández-del Castillo C, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg, 1995, 130(3): 295-299.
6. Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery, 2003, 133(5): 521-527.
7. Strasberg SM, Linehan DC, Hawkins WG. Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg, 2007, 204(2): 244-249.
8. Mitchem JB, Hamilton N, Gao F, et al. Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg, 2012, 214(1): 46-52.
9. Kitagawa H, Tajima H, Nakagawara H, et al. A modification of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the left pancreas: significance of en bloc resection including the anterior renal fascia. World J Surg, 2014, 38(9): 2448-2454.
10. Chang YR, Han SS, Park SJ, et al. Surgical outcome of pancreatic cancer using radical antegrade modular pancreatosplenectomy procedure. World J Gastroenterol, 2012, 18(39): 5595-5600.
11. Rosso E, Langella S, Addeo P, et al. A safe technique for radical antegrade modular pancreatosplenectomy with venous resection for pancreatic cancer. J Am Coll Surg, 2013, 217(5): e35-e39.
12. 徐冬, 蒋奎荣, 陆子鹏, 等. 根治性顺行模块化胰脾切除术治疗胰体尾癌的临床疗效. 中华消化外科杂志, 2016, 15(6): 567-573.
13. Scoazec JY, Sabourin JC. 2010: the seventh edition of the TNM classification. Ann Pathol, 2010, 30(1): 2-6.
14. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
15. Healy JM, Kunstman JW, Salem RR. Proposal and critical appraisal of exclusion criteria to the international study group for pancreatic surgery definition of delayed gastric emptying. J Am Coll Surg, 2015, 220(6): 1036-1043.
16. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
17. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
18. Cao F, Li J, Li A, et al. Radical antegrade modular pancreatosplenectomy versus standard procedure in the treatment of left-sided pancreatic cancer: a systemic review and meta-analysis. BMC Surg, 2017, 17(1): 67.
19. Zhou Y, Shi B, Wu L, et al. A systematic review of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. HPB (Oxford), 2017, 19(1): 10-15.
20. Grossman JG, Fields RC, Hawkins WG, et al. Single institution results of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of pancreas in 78 patients. J Hepatobiliary Pancreat Sci, 2016, 23(7): 432-441.
21. Lillemoe KD, Kaushal S, Cameron JL, et al. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg, 1999, 229(5): 693-698.
22. Abe T, Ohuchida K, Miyasaka Y, et al. Comparison of Surgical Outcomes Between Radical Antegrade Modular Pancreatosplenectomy (RAMPS) and Standard Retrograde Pancreatosplenectomy (SPRS) for left-sided pancreatic cancer. World J Surg, 2016, 40(9): 2267-2275.
23. Park HJ, You DD, Choi DW, et al. Role of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. World J Surg, 2014, 38(1): 186-193.
24. Trottman P, Swett K, Shen P, et al. Comparison of standard distal pancreatectomy and splenectomy with radical antegrade modular pancreatosplenectomy. Am Surg, 2014, 80(3): 295-300.
25. Latorre M, Ziparo V, Nigri G, et al. Standard retrograde pancreatosplenectomy versus radical antegrade modular pancreatosplenectomy for body and tail pancreatic adenocarcinoma. Am Surg, 2013, 79(11): 1154-1158.
26. Kim EY, You YK, Kim DG, et al. Initial experience with radical antegrade modular pancreatosplenectomy in a single institution. Ann Surg Treat Res, 2016, 91(1): 29-36.
27. Verbeke CS, Leitch D, Menon KV, et al. Redefining the R1 resection in pancreatic cancer. Br J Surg, 2006, 93(10): 1232-1237.
28. Hsu CC, Herman JM, Corsini MM, et al. Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. Ann Surg Oncol, 2010, 17(4): 981-990.
29. 纪宗正, 张焱. 胰体尾癌的综合治疗. 中国普外基础与临床杂志, 2011, 18(1): 3-5.
30. Miller RC, Iott MJ, Corsini MM. Review of adjuvant radiochemotherapy for resected pancreatic cancer and results from Mayo Clinic for the 5^th JUCTS symposium. Int J Radiat Oncol Biol Phys, 2009, 75(2): 364-368.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preliminary experience of radical antegrade modular pancreatosplenectomy for pancreatic body and tail cancer: report of 52 cases

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content