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Minimally invasive RAMPS in well-selected left-sided pancreatic cancer within Yonsei criteria: long-term (>median 3 years) oncologic outcomes

Authors
 Sung Hwan Lee  ;  Chang Moo Kang  ;  Ho Kyoung Hwang  ;  Sung Hoon Choi  ;  Woo Jung Lee  ;  Hoon Sang Chi 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.28(10) : 2848-2855, 2014 
Journal Title
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 
ISSN
 0930-2794 
Issue Date
2014
MeSH
Female ; Follow-Up Studies ; Humans ; Laparoscopy* ; Length of Stay/statistics & numerical data ; Lymph Node Excision ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Pancreatectomy/methods* ; Pancreatic Neoplasms/mortality ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery* ; Patient Selection ; Postoperative Complications ; Retrospective Studies ; Robotic Surgical Procedures* ; Splenectomy/methods*
Keywords
Minimally invasive surgery ; RAMPS ; Pancreatic cancer ; Oncologic outcome
Abstract
BACKGROUND: Although minimally invasive techniques for distal pancreatectomy with or without splenectomy have been regarded as a feasible and safe treatment option for benign and borderline malignant lesions of the pancreas, the management of left-sided pancreatic cancer remains controversial. METHODS: From June 2007 to November 2010, 12 patients underwent laparoscopic or robotic radical antegrade modular pancreatosplenectomy (RAMPS) for well-selected left-sided pancreatic cancer. The Yonsei criteria for patient selection included the following conditions: (1) tumor confined to the pancreas, (2) intact fascial layer between the distal pancreas and the left adrenal gland and kidney, and (3) tumor located more than 1-2 cm from the celiac axis. We compared the clinicopathologic factors and oncologic outcomes of the minimally invasive surgery (MIS) and the conventional open surgery groups for treating left-sided pancreatic cancer. RESULTS: In the MIS group, the mean tumor size was 2.75 ± 1.32 cm, and the mean number of retrieved lymph nodes was 10.5 ± 7.14. The resection margins were confirmed to be negative for malignancy in all patients. The MIS group and open group (n = 78) were statistically different in terms of tumor size (2.8 ± 1.3 vs. 3.5 ± 1.9 cm, p = 0.05) and length of hospital stay (12.3 ± 6.8 vs. 22.4 ± 21.6 days, p = 0.002). On survival analysis, the MIS group had longer disease-free survival (DFS) and overall survival (OS) than the open group (DFS: 47.6 vs. 24.7 months, p = 0.027; OS: 60.0 vs. 30.7 months, p = 0.046). In order to overcome the heterogeneity of subjects between the MIS and the open group, we performed statically matched comparisons using the propensity score analysis and then divided the open group into two subgroups according to the Yonsei criteria. There were no significant differences in median overall survival between the MIS group and the open group that met the Yonsei criteria (60.00 vs. 60.72 months, p = 0.616). CONCLUSIONS: Minimally invasive RAMPS is not only technically feasible but also oncologically safe in cases of well-selected left-sided pancreatic cancer. Our selection criteria for minimally invasive RAMPS needs to be further validated based on additional large-volume studies.
Full Text
http://link.springer.com/article/10.1007%2Fs00464-014-3537-3
DOI
10.1007/s00464-014-3537-3
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Lee, Sung Hwan(이성환)
Lee, Woo Jung(이우정) ORCID logo https://orcid.org/0000-0001-9273-261X
Hwang, Ho Kyoung(황호경) ORCID logo https://orcid.org/0000-0003-4064-7776
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99960
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