Radical antegrade modular pancreatosplenectomy versus standard distal pancreatosplenectomy for pancreatic cancer, a dual-institutional analysis

Jonathan G. Sham, Shiwei Guo, Ding Ding, Zhuo Shao, Michael Wright, Wei Jing, Ling Di Yin, Yijie Zhang, Michele M. Gage, Yingqi Zhou, Ammar Javed, Richard A. Burkhart, Xuyu Zhou, Matthew J. Weiss, Tianlin He, Gang Li, John L. Cameron, Xiangui Hu, Christopher L. Wolfgang, Gang JinJin He

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Radical antegrade modular pancreatosplenectomy (RAMPS) has been adopted by some surgeons in the treatment of left-sided pancreatic cancer (PDAC). Low disease incidence and heterogenous disease biology make robust prospective comparison of RAMPS and standard distal pancreatosplenectomy (DPS) difficult. Methods: Consecutive cases of chemo-naïve patients undergoing open RAMPS and DPS for PDAC between 2010-2017 at two international high-volume pancreatectomy centers were compared. Cox proportional hazard modeling was utilized for multivariate analysis. Results: We identified 193 DPS and 253 RAMPS during the study period. DPS was associated with higher rates of median estimated blood loss (500 vs. 300 cc, P<0.001), median total harvested lymph nodes (18 vs. 12, P<0.001) and R0 resection (94.3% vs. 88.9%, P=0.013). There were no differences in rates of postoperative pancreatic fistula (16.5% vs. 17.8%, P=1) or postoperative hemorrhage (5.9% vs. 3.6%, P=0.385) (DPS vs. RAMPS). After controlling for significant clinical pathological parameters, RAMPS was associated with non-superior recurrence-free survival (RFS) (HR 0.29; 95% CI, 0.07-1.27, P=0.101) and overall-survival (HR 1.03; 95% CI, 0.71-1.49, P=0.895) compared with DPS. Similar results were observed in node-positive patients. Conclusions: RAMPS is safe and effective in the treatment of PDAC, but is not associated with an improvement in either RFS or overall-survival over DPS.

Original languageEnglish (US)
Article numbere6
JournalChinese Clinical Oncology
Volume9
Issue number4
DOIs
StatePublished - Aug 2020

Keywords

  • Distal pancreatosplenectomy
  • Pancreatic cancer

ASJC Scopus subject areas

  • Oncology

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