Comparison of Survival Outcomes between Radical Antegrade Modular Pancreatosplenectomy and Conventional Distal Pancreatosplenectomy for Pancreatic Body and Tail Cancer: Korean Multicenter Propensity Score Match Analysis

• Published in: Cancers 2024-04, Vol.16 (8), p.1546
• Main Authors: Kwon, Jaewoo, Lee, Huisong, Kim, Hongbeom, Kim, Sung Hyun, Yang, Jae Do, Lee, Woohyung, Lee, Jun Suh, Shin, Sang Hyun, Kim, Hee Joon
• Format: Article
• Language: English
• Subjects: Adjuvant therapy; Antigens; Dissection; Fistula; Hospitals; Lymph nodes; Lymphatic system; Medical prognosis; Metastasis; Morbidity; Mortality; Multivariate analysis; Pancreatic cancer; Patients; Survival
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers16081546

(1) Background: The aim of this study was to compare the survival benefit of radical antegrade modular pancreatosplenectomy (RAMPS) with conventional distal pancreatosplenectomy (cDPS) in left-sided pancreatic cancer. (2) Methods: A retrospective propensity score matching (PSM) analysis was conducted on 333 patients who underwent RAMPS or cDPS for left-sided pancreatic cancer at four tertiary cancer centers. The study assessed prognostic factors and compared survival and operative outcomes. (3) Results: After PSM, 99 patients were matched in each group. RAMPS resulted in a higher retrieved lymph node count than cDPS (15.0 vs. 10.0, < 0.001). No significant differences were observed between the two groups in terms of R0 resection rate, blood loss, hospital stay, or morbidity. The 5-year overall survival rate was similar in both groups (cDPS vs. RAMPS, 44.4% vs. 45.2%, = 0.853), and disease-free survival was also comparable. Multivariate analysis revealed that ASA score, preoperative CA19-9, histologic differentiation, R1 resection, adjuvant treatment, and lymphovascular invasion were significant prognostic factors for overall survival. Preoperative CA19-9, histologic differentiation, T-stage, adjuvant treatment, and lymphovascular invasion were independent significant prognostic factors for disease-free survival. (4) Conclusions: Although RAMPS resulted in a higher retrieved lymph node count, survival outcomes were not different between the two groups. RAMPS was a surgical option to achieve R0 resection rather than a standard procedure.