Kim Eun Young, You Young Kyoung, Kim Dong Goo, Hong Tae Ho
Department of Hepato-biliary and Pancreas Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Ann Surg Treat Res. 2016 Jul;91(1):29-36. doi: 10.4174/astr.2016.91.1.29. Epub 2016 Jun 30.
Radical antegrade modular pancreatosplenectomy (RAMPS) is expected to be favorable for obtaining the negative tangential margin with oncologic feasibility through the horizontal dissection in a right-to-left fashion for radical lymph node dissections.
From January 2007 to February 2015, a total of 30 RAMPS and 19 conventional distal pancreatectomy (DP) cases were enrolled. The demographics, perioperative and survival outcomes were compared according to the type of surgery.
The mean operative time, blood loss and length of hospital stay were similar between 2 groups. Morbidities were reported in 14 cases of RAMPS (46.7%) and 8 cases of DP (42.1%) (P = 0.777). The rate of negative tangential margin (96.2%) and the number of harvested lymph nodes (mean ± standard deviation, 21.5 ± 8.3) were significantly higher in RAMPS group (P = 0.011, P = 0.003, respectively). In terms of survival outcomes, there was no significant difference in regard to the overall 3-year disease-free survival (DFS; 30.4% in RAMPS vs. 35.0% in DP, P = 0.354) or overall survival (OS; 29.9% vs. 29.4%, P = 0.429) between the 2 groups. After exclusion of cases with nodal invasion, however, the RAMPS group had a longer DFS than the DP group (55.6% vs. 27.3%, P = 0.048) although OS was similar without significant difference (42.4% vs. 27.3%, P = 0.197).
RAMPS is a safe and oncologically feasible procedure in left-sided pancreatic cancer by obtaining a successful negative tangential margin and radical lymph node dissection. The authors suggest it could also be useful for local control, especially for the limited left-sided pancreatic cancer without nodal invasion.
根治性顺行模块化胰脾切除术（RAMPS）有望通过从右向左水平解剖进行根治性淋巴结清扫，在肿瘤学可行性方面有利于获得阴性切缘。
2007年1月至2015年2月，共纳入30例RAMPS病例和19例传统远端胰腺切除术（DP）病例。根据手术类型比较人口统计学、围手术期和生存结果。
两组的平均手术时间、失血量和住院时间相似。RAMPS组有14例（46.7%）出现并发症，DP组有8例（42.1%）出现并发症（P = 0.777）。RAMPS组的阴性切缘率（96.2%）和清扫淋巴结数量（平均值±标准差，21.5±8.3）显著更高（分别为P = 0.011，P = 0.003）。在生存结果方面，两组的3年总体无病生存率（DFS；RAMPS组为30.4%，DP组为35.0%，P = 0.354）或总体生存率（OS；29.9%对29.4%，P = 0.429）无显著差异。然而，排除有淋巴结转移的病例后，RAMPS组的DFS长于DP组（55.6%对27.3%，P = 0.048），尽管OS相似且无显著差异（42.4%对27.3%，P = 0.197）。
RAMPS是一种安全且在肿瘤学上可行的手术方法，可成功获得阴性切缘并进行根治性淋巴结清扫，适用于左侧胰腺癌。作者认为它对局部控制也可能有用，特别是对于没有淋巴结转移的局限性左侧胰腺癌。
