Kwon Jaewoo, Park Yejong, Jun Eunsung, Lee Woohyung, Song Ki Byung, Lee Jae Hoon, Hwang Dae Wook, Kim Song Cheol
Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul 05505, Korea.
Biomedicines. 2021 Sep 22;9(10):1291. doi: 10.3390/biomedicines9101291.
Radical antegrade modular pancreatosplenectomy (RAMPS) is considered an effective procedure for left-sided pancreatic ductal adenocarcinoma (PDAC). However, whether there are differences in perioperative outcomes, pathologies, or survival outcomes between anterior RAMPS (aRAMPS) and posterior RAMPS (pRAMPS) has not been reported previously. We retrospectively reviewed and compared the demographic, perioperative, histopathologic, and survival data of patients who underwent aRAMPS or pRAMPS for PDAC. We also compared these two groups among patients without periadrenal infiltration or adrenal invasion. A total of 112 aRAMPS patients and 224 pRAMPS patients were evaluated. Periadrenal infiltration, neoadjuvant treatment, and concurrent vessel resection were more prevalent in the pRAMPS group. After excluding patients with periadrenal infiltration, 106 aRAMPS patients were compared with 157 pRAMPS patients. There were no significant differences between the aRAMPS and pRAMPS groups in the pathologic tumor size, resection margin, proportion of tangential margin in the R1 resection, and number of harvested lymph nodes. The median overall survival and disease-free survival also did not differ significantly between the two groups. We cautiously suggest that pRAMPS will not necessarily provide more beneficial histopathologic outcomes and survival rates for left-sided PDAC cases without periadrenal infiltration. If periadrenal infiltration is not suspected, aRAMPS alone should be sufficiently effective.
根治性顺行模块化胰脾切除术（RAMPS）被认为是治疗胰体尾导管腺癌（PDAC）的有效术式。然而，此前尚无关于前入路RAMPS（aRAMPS）和后入路RAMPS（pRAMPS）在围手术期结局、病理情况或生存结局方面是否存在差异的报道。我们回顾性分析并比较了接受aRAMPS或pRAMPS治疗PDAC患者的人口统计学、围手术期、组织病理学和生存数据。我们还在无肾上腺周围浸润或肾上腺侵犯的患者中比较了这两组。共评估了112例接受aRAMPS治疗的患者和224例接受pRAMPS治疗的患者。肾上腺周围浸润、新辅助治疗和同期血管切除在pRAMPS组更为常见。排除肾上腺周围浸润患者后，将106例接受aRAMPS治疗的患者与157例接受pRAMPS治疗的患者进行比较。aRAMPS组和pRAMPS组在病理肿瘤大小、切缘、R1切除中切线切缘比例及清扫淋巴结数目方面无显著差异。两组的中位总生存期和无病生存期也无显著差异。我们谨慎地认为，对于无肾上腺周围浸润的胰体尾PDAC病例，pRAMPS不一定能提供更有利的组织病理学结局和生存率。如果不怀疑有肾上腺周围浸润，单独行aRAMPS应足够有效。
