Key points and considerations of difficult laparoscopic radical antegrade modular pancreatosplenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Zheng , LIU Wensheng , SHI Yihua , JI Shunrong , YU Xianjun ,  XU Xiaowu

Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University; Shanghai Pancreatic Cancer Institute; Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P. R. China;

Corresponding author：

XU Xiaowu, Email: xuxiaowu@fudanpci.org

Keywords：

pancreatic cancer; laparoscopic radical antegrade modular pancreatosplenectomy; key surgical point

DOI：

10.7507/1007-9424.202309025

Video：

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Compared with open surgery, laparoscopic radical resection of the body and tail pancreatic cancer is gradually being accepted due to its shorter hospital stay, reduced intraoperative blood loss, and comparable perioperative and oncological prognosis. The proposal of radical antegrade modular pancreatosplenectomy (RAMPS) has established a standardized approach for resection scope and lymph node dissection in pancreatic body and tail cancers. Studies have confirmed that RAMPS surgery can achieve a higher N1 station lymph node dissection, R0 margin ratio, and satisfactory patient survival rates. Furthermore, RAMPS has demonstrated oncological advantages in terms of postoperative local control. Laparoscopic RAMPS (LRAMPS) has been shown to be technically feasible and to yield long-term oncologic outcomes comparable to open RAMPS. An increasing number of studies have evaluated LRAMPS as the standard surgical modality for resectable body and tail pancreatic cancers. This article discusses the main points and challenges of LRAMPS surgery, and presents some personal experiences.

Citation： LI Zheng, LIU Wensheng, SHI Yihua, JI Shunrong, YU Xianjun, XU Xiaowu. Key points and considerations of difficult laparoscopic radical antegrade modular pancreatosplenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(11): 1284-1288. doi: 10.7507/1007-9424.202309025 Copy

1.	de Rooij T, van Hilst J, van Santvoort H, et al. Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg, 2019, 269(1): 2-9.
2.	van Hilst J, de Rooij T, Klompmaker S, et al. Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study. Ann Surg, 2019, 269(1): 10-17.
3.	Asbun HJ, Moekotte AL, Vissers FL, et al. The miami international evidence-based guidelines on minimally invasive pancreas resection. Ann Surg, 2020, 271(1): 1-14.
4.	Korrel M, Jones LR, van Hilst J, et al. Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): an international randomised non-inferiority trial. Lancet Reg Health Eur, 2023, 31: 100673. doi: 10.1016/ j.lanepe.2023.100673.
5.	Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery, 2003, 133(5): 521-527.
6.	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.
7.	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.
8.	Takahashi A, Mise Y, Watanabe G, et al. Radical antegrade modular pancreatosplenectomy enhances local control of the disease in patients with left-sided pancreatic cancer. HPB (Oxford), 2023, 25(1): 37-44.
9.	Tang W, Zhang YF, Zhao YF, et al. Comparison of laparoscopic versus open radical antegrade modular pancreatosplenectomy for pancreatic cancer: a systematic review and meta-analysis. Int J Surg, 2022, 103: 106676. doi: 10.1016/j.ijsu.2022.106676.
10.	Zhang H, Li Y, Liao Q, et al. Comparison of minimal invasive versus open radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic ductal adenocarcinoma: a single center retrospective study. Surg Endosc, 2021, 35(7): 3763-3773.
11.	Wu EJ, Kabir T, Zhao JJ, et al. Minimally invasive versus open radical antegrade modular pancreatosplenectomy: a meta-analysis. World J Surg, 2022, 46(1): 235-245.
12.	Lee SH, Kang CM, Hwang HK, et al. Minimally invasive RAMPS in well-selected left-sided pancreatic cancer within Yonsei criteria: long-term (>median 3 years) oncologic outcomes. Surg Endosc, 2014, 28(10): 2848-2855.
13.	Sato S, Oba A, Kato T, et al. Feasibility of laparoscopic radical antegrade modular pancreatosplenectomy (RAMPS) as a standard treatment for distal resectable pancreatic cancer. Langenbecks Arch Surg, 2023, 408(1): 217. doi: 10.1007/s00423-023-02942-0.
14.	Sutton TL, Potter KC, Mayo SC, et al. Complications in distal pancreatectomy versus radical antegrade modular pancreatosplenectomy: a disease risk score analysis utilizing national surgical quality improvement project data. World J Surg, 2022, 46(7): 1768-1775.
15.	Klompmaker S, Peters NA, van Hilst J, et al. Outcomes and risk score for distal pancreatectomy with celiac axis resection (DP-CAR): an international multicenter analysis. Ann Surg Oncol, 2019, 26(3): 772-781.
16.	Yoon SJ, Park SJ, Yoon YS, et al. 15-year experience of distal pancreatectomy with celiac axis resection (DP-CAR) for pancreatic cancer-a Korean nationwide investigation. Cancers (Basel), 2023, 15(15): 3850. doi: 10.3390/cancers15153850.
17.	Ikoma N, Katz MHG. Improving outcomes after distal pancreatectomy with celiac axis resection (DP-CAR): as always, it is all about patient selection. Ann Surg Oncol, 2019, 26(3): 703-704.

1. de Rooij T, van Hilst J, van Santvoort H, et al. Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg, 2019, 269(1): 2-9.
2. van Hilst J, de Rooij T, Klompmaker S, et al. Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study. Ann Surg, 2019, 269(1): 10-17.
3. Asbun HJ, Moekotte AL, Vissers FL, et al. The miami international evidence-based guidelines on minimally invasive pancreas resection. Ann Surg, 2020, 271(1): 1-14.
4. Korrel M, Jones LR, van Hilst J, et al. Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): an international randomised non-inferiority trial. Lancet Reg Health Eur, 2023, 31: 100673. doi: 10.1016/ j.lanepe.2023.100673.
5. Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery, 2003, 133(5): 521-527.
6. 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.
7. 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.
8. Takahashi A, Mise Y, Watanabe G, et al. Radical antegrade modular pancreatosplenectomy enhances local control of the disease in patients with left-sided pancreatic cancer. HPB (Oxford), 2023, 25(1): 37-44.
9. Tang W, Zhang YF, Zhao YF, et al. Comparison of laparoscopic versus open radical antegrade modular pancreatosplenectomy for pancreatic cancer: a systematic review and meta-analysis. Int J Surg, 2022, 103: 106676. doi: 10.1016/j.ijsu.2022.106676.
10. Zhang H, Li Y, Liao Q, et al. Comparison of minimal invasive versus open radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic ductal adenocarcinoma: a single center retrospective study. Surg Endosc, 2021, 35(7): 3763-3773.
11. Wu EJ, Kabir T, Zhao JJ, et al. Minimally invasive versus open radical antegrade modular pancreatosplenectomy: a meta-analysis. World J Surg, 2022, 46(1): 235-245.
12. Lee SH, Kang CM, Hwang HK, et al. Minimally invasive RAMPS in well-selected left-sided pancreatic cancer within Yonsei criteria: long-term (>median 3 years) oncologic outcomes. Surg Endosc, 2014, 28(10): 2848-2855.
13. Sato S, Oba A, Kato T, et al. Feasibility of laparoscopic radical antegrade modular pancreatosplenectomy (RAMPS) as a standard treatment for distal resectable pancreatic cancer. Langenbecks Arch Surg, 2023, 408(1): 217. doi: 10.1007/s00423-023-02942-0.
14. Sutton TL, Potter KC, Mayo SC, et al. Complications in distal pancreatectomy versus radical antegrade modular pancreatosplenectomy: a disease risk score analysis utilizing national surgical quality improvement project data. World J Surg, 2022, 46(7): 1768-1775.
15. Klompmaker S, Peters NA, van Hilst J, et al. Outcomes and risk score for distal pancreatectomy with celiac axis resection (DP-CAR): an international multicenter analysis. Ann Surg Oncol, 2019, 26(3): 772-781.
16. Yoon SJ, Park SJ, Yoon YS, et al. 15-year experience of distal pancreatectomy with celiac axis resection (DP-CAR) for pancreatic cancer-a Korean nationwide investigation. Cancers (Basel), 2023, 15(15): 3850. doi: 10.3390/cancers15153850.
17. Ikoma N, Katz MHG. Improving outcomes after distal pancreatectomy with celiac axis resection (DP-CAR): as always, it is all about patient selection. Ann Surg Oncol, 2019, 26(3): 703-704.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Key points and considerations of difficult laparoscopic radical antegrade modular pancreatosplenectomy

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