Sivasanker Masillamany, Desouza Ashwin, Bhandare Manish, Chaudhari Vikram, Goel Mahesh, Shrikhande Shailesh V
Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Department of Gastrointestinal and HPB Surgery, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400012, India.
Langenbecks Arch Surg. 2019 Mar;404(2):183-190. doi: 10.1007/s00423-019-01763-4. Epub 2019 Feb 21.
Radical antegrade modular pancreatosplenectomy (RAMPS) has been propagated as the standard of care for pancreatic cancers involving the body and tail of the pancreas. This procedure has been shown to have promising results in enhancing the microscopically negative tangential resection margins as well as the lymph node yield.
This is a retrospective analysis of prospectively maintained database on the resections performed for all pancreatic body and tail tumors at Tata Memorial Centre.
Sixty-five patients underwent RAMPS without any perioperative mortality. The various pathologies comprised of adenocarcinoma (41.5%), neuroendocrine tumors (12.3%), solid pseudopapillary epithelial neoplasm (15.3%), cystic neoplasms (15.2%), etc. The R0 resection rate was 87.7%. Among this cohort, 27 patients had pancreatic adenocarcinoma. The 3-year OS and DFS for distal pancreatic cancers were 56% and 38%, respectively, but 3-year OS and DFS for other distal pancreatic tumors were 97% and 73%, respectively. On multivariate analysis, R0 resection significantly improved disease-free survival (p = 0.023) for pancreatic cancer.
RAMPS procedure aids to achieve high negative tangential margins for all tumors involving the body and tail of the pancreas and not just pancreatic cancer in isolation. Since preoperative histologic diagnosis is not routinely indicated and also a number of other distal pancreatic tumors carry a relatively better prognosis compared with pancreatic cancer, our results provide further evidence that RAMPS should be considered as the procedure of choice for all operable tumors involving body and tail of the pancreas.
根治性顺行模块化胰脾切除术（RAMPS）已被推广为治疗累及胰体和胰尾的胰腺癌的标准术式。该手术在提高显微镜下切缘阴性率以及淋巴结清扫数量方面已显示出有前景的结果。
这是一项对塔塔纪念中心所有胰体和胰尾肿瘤切除术的前瞻性维护数据库的回顾性分析。
65例患者接受了RAMPS手术，无围手术期死亡。各种病理类型包括腺癌（41.5%）、神经内分泌肿瘤（12.3%）、实性假乳头状上皮性肿瘤（15.3%）、囊性肿瘤（15.2%）等。R0切除率为87.7%。在该队列中，27例患者患有胰腺腺癌。胰体尾癌的3年总生存率（OS）和无病生存率（DFS）分别为56%和38%，但其他胰体尾肿瘤的3年OS和DFS分别为97%和73%。多因素分析显示，R0切除显著改善了胰腺癌的无病生存率（p = 0.023）。
RAMPS手术有助于为所有累及胰体和胰尾的肿瘤，而不仅仅是孤立的胰腺癌，实现高阴性切缘。由于术前组织学诊断并非常规必需，而且与胰腺癌相比，许多其他胰体尾肿瘤的预后相对较好，我们的结果提供了进一步的证据，表明RAMPS应被视为所有可切除的累及胰体和胰尾肿瘤的首选手术方式。
