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Radical antegrade modular pancreatosplenectomy (RAMPS) versus conventional distal pancreatectomy for left-sided pancreatic cancer: findings of a multicenter, retrospective, propensity score matching study

 Hyung Sun Kim  ;  Tae Ho Hong  ;  Young-Kyoung You  ;  Joon Seong Park  ;  Dong Sup Yoon 
 SURGERY TODAY, Vol.51(11) : 1775-1786, 2021-11 
Journal Title
Issue Date
Aged ; Chemotherapy, Adjuvant* ; Disease-Free Survival ; Female ; Humans ; Kaplan-Meier Estimate ; Lymph Node Excision ; Lymphatic Metastasis / pathology ; Male ; Margins of Excision ; Middle Aged ; Multicenter Studies as Topic* ; Pancreas / surgery ; Pancreatectomy / methods* ; Pancreatic Neoplasms / drug therapy ; Pancreatic Neoplasms / mortality ; Pancreatic Neoplasms / pathology ; Pancreatic Neoplasms / surgery* ; Propensity Score* ; Retrospective Studies ; Splenectomy / methods* ; Treatment Outcome
Body and tail pancreatic cancer ; Conventional distal pancreatectomy ; Left side pancreatic cancer ; Radical antegrade modular pancreatosplenectomy (RAMPS)
Purpose: Radical antegrade modular pancreatosplenectomy (RAMPS) has been reported to achieve high rates of a negative margin and resected metastatic lymph nodes. However, many studies have used historical controls and the results remain controversial. We conducted this study to compare the surgical and long-term outcomes of RAMPS vs. conventional distal pancreatectomy (DP).

Methods: The subjects of this multicenter retrospective study were 106 patients who underwent curative resection for left-sided pancreatic cancer between 2012 and 2017. Overall survival (OS) and recurrence-free survival (RFS) rates were compared using Kaplan-Meier estimates.

Results: The RAMPS group had more advanced T (T3/T4) and N stages (N1/N2) and a larger tumor size than the conventional group (T stage, p = 0.04; N stage, p = 0.02; tumor size, p = 0.04). The RAMPS group had more harvested metastatic lymph nodes (p = 0.02). After propensity-score matching, 37 patients from each group were included in the final analysis. There was no significant difference in RFS (p = 0.463) or OS (p = 0.383) between the groups. Multivariate analyses revealed the completion of chemotherapy to be an independent factor for RFS and OS (both p < 0.001).

Conclusions: There was no difference in the RFS or OS between RAMPS and conventional DP in this series. RAMPS may be an option for R0 resection of advanced tumors; however, postoperative chemotherapy has a greater influence than the surgical procedure on the prognosis of patients with pancreatic cancer.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyung Sun(김형선) ORCID logo https://orcid.org/0000-0002-9002-3569
Park, Joon Seong(박준성) ORCID logo https://orcid.org/0000-0001-8048-9990
Yoon, Dong Sup(윤동섭) ORCID logo https://orcid.org/0000-0001-6444-9606
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