Department of Surgery, Oregon Heath & Science University (OHSU), Portland, OR, 97239, USA.
School of Medicine, OHSU, Portland, OR, 97239, USA.
World J Surg. 2022 Jul;46(7):1768-1775. doi: 10.1007/s00268-022-06545-6. Epub 2022 Apr 11.
Radical antegrade modular pancreatosplenectomy (RAMPS) was developed to improve R0 resections and lymph node harvests versus distal pancreatectomy (DP) in pancreatic adenocarcinoma (PDAC); relative complication rates are understudied.
Patients undergoing distal pancreas resections from 2006 to 2020 were identified from our institutional NSQIP database, grouped by resection method, and evaluated for the following outcomes: postoperative pancreatic fistula (POPF), clinically relevant POPF (crPOPF), incisional surgical site infection (iSSI), organ space SSI (osSSI), and Clavien-Dindo grade ≥ 3 (CD ≥ 3) complications using logistic regression. Patients were matched 1:1 based on disease risk score.
Two-hundred-thirty-six and 117 patients underwent DP and RAMPS, respectively. POPF, crPOPF, CD ≥ 3 complications, iSSI, and osSSIs occurred in 105 (30%), 43 (12%), 74 (21%), 34 (10%) and 52 (15%) patients, respectively. Disease risk score matching yielded 89 similar patients per group. On multivariable analysis, patients undergoing RAMPS were not significantly more likely to experience POPF (OR 0.69, P = 0.26), crPOPF (OR 0.41, P = 0.72), CD ≥ 3 complication (OR 0.78, P = 0.44), iSSI (OR 0.58, P = 0.27), or osSSI (OR 0.93, P = 0.86). Of patients with PDAC (n = 108) mean nodal harvest were 14.8 (SD 11.30) and 19.4 (SD 7.19) nodes for patients undergoing DP and RAMPS, respectively (P = 0.01). Six patients (20%) undergoing DP had positive margins versus 12 (15%) undergoing RAMPS (P = 0.56). At a median follow-up of 17 months, there was no difference in locoregional recurrence-free survival (P = 0.32) or overall survival (P = 0.92) on Kaplan-Meier analysis.
RAMPS does not result in increased complications compared to DP and routine use is encouraged in pancreatic malignancies.
根治性顺行模块胰体尾切除术（RAMPS）旨在提高胰腺腺癌（PDAC）患者的 R0 切除率和淋巴结清扫率，优于胰体尾切除术（DP）；但相对并发症发生率尚未得到充分研究。
从我们的机构 NSQIP 数据库中确定了 2006 年至 2020 年期间接受远端胰腺切除术的患者，根据手术方法分组，并评估以下结果：术后胰瘘（POPF）、临床相关的 POPF（crPOPF）、切口手术部位感染（iSSI）、器官间隙感染（osSSI）和 Clavien-Dindo 分级≥3（CD≥3）并发症，使用逻辑回归。根据疾病风险评分对患者进行 1:1 匹配。
236 例患者接受 DP 治疗，117 例患者接受 RAMPS 治疗。105 例（30%）、43 例（12%）、74 例（21%）、34 例（10%）和 52 例（15%）患者分别发生 POPF、crPOPF、CD≥3 并发症、iSSI 和 osSSI。多变量分析显示，每组各有 89 例类似患者。在多变量分析中，接受 RAMPS 治疗的患者发生 POPF 的可能性（OR 0.69，P=0.26）、crPOPF（OR 0.41，P=0.72）、CD≥3 并发症（OR 0.78，P=0.44）、iSSI（OR 0.58，P=0.27）或 osSSI（OR 0.93，P=0.86）的可能性均无显著差异。在接受 DP 治疗的 108 例 PDAC 患者中，平均淋巴结清扫量分别为 14.8（SD 11.30）和 19.4（SD 7.19）个，接受 DP 和 RAMPS 治疗的患者（P=0.01）。6 例（20%）接受 DP 治疗的患者有阳性切缘，12 例（15%）接受 RAMPS 治疗的患者有阳性切缘（P=0.56）。在中位随访 17 个月时，Kaplan-Meier 分析显示局部区域无复发生存率（P=0.32）或总生存率（P=0.92）无差异。
与 DP 相比，RAMPS 不会导致并发症增加，建议在胰腺恶性肿瘤中常规使用。
