Anterior versus posterior radical antegrade modular pancreatosplenectomy for pancreatic body and tail cancer: an inverse probability of treatment weighting with survival analysis

Purpose Radical antegrade modular pancreatosplenectomy (RAMPS) is a standard procedure for patients with pancreatic body and tail cancer. There are two types of RAMPS: anterior and posterior, but their indications and surgical outcomes remain unclear. We compared the surgical outcomes, postoperative...

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Bibliographic Details
Published in:Surgery today (Tokyo, Japan) Japan), 2023-08, Vol.53 (8), p.917-929
Main Authors: Kuriyama, Naohisa, Maeda, Koki, Shinkai, Toru, Ito, Takahiro, Gyoten, Kazuyuki, Hayasaki, Aoi, Fujii, Takehiro, Iizawa, Yusuke, Murata, Yasuhiro, Tanemura, Akihiro, Kishiwada, Masashi, Nagata, Motonori, Ichikawa, Shuhei, Mizuno, Shugo
Format: Article
Language:English
Subjects:
Medicine
Medicine & Public Health
Original Article
Surgery
Surgical Oncology
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Summary:Purpose Radical antegrade modular pancreatosplenectomy (RAMPS) is a standard procedure for patients with pancreatic body and tail cancer. There are two types of RAMPS: anterior and posterior, but their indications and surgical outcomes remain unclear. We compared the surgical outcomes, postoperative course, and prognosis between anterior and posterior RAMPS. Methods Between 2007 and 2020, 105 consecutive patients who underwent RAMPS for pancreatic body and tail cancers were divided into an anterior RAMPS group ( n  = 30) and a posterior RAMPS group ( n  = 75). To adjust for differences in preoperative characteristics and intraoperative procedures, an inverse probability of treatment weighting (IPTW) analysis was done, using propensity scores. Results After IPTW adjustment, the postoperative body temperature of the posterior RAMPS group and the amount of drain discharge in the anterior RAMPS group were significantly lower, from postoperative days (PODs) 1 to 3, but there were no differences in postoperative complications, recurrence patterns, or prognosis between the two groups. Regarding the diagnostic ability of multidetector-row computed tomography (MD-CT) for direct tumor involvement of the left adrenal gland, the sensitivity and specificity were 100% and 90.0%, respectively. Conclusion Pancreatic body and tail cancer without apparent preoperative direct tumor involvement of the left adrenal gland on MD-CT may be sufficient indication for anterior RAMPS.
ISSN:0941-1291
1436-2813
DOI:10.1007/s00595-023-02651-7