Clinical Outcome of RAMPS for Left-Sided Pancreatic Ductal Adenocarcinoma: A Comparison of Anterior RAMPS versus Posterior RAMPS for Patients without Periadrenal Infiltration

Abstract

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.

Keywords: RAMPS; adrenalectomy; distal pancreatectomy; pancreatic cancer.

Figure 1

Study patient flow diagram. A retrospective review was conducted of 336 patients who underwent a distal pancreatectomy. Of these cases, 112 patients underwent aRAMPS and 224 patients underwent pRAMPS. After excluding patients with periadrenal infiltration or adrenal invasion evident on preoperative computed tomography or magnetic resonance imaging, 106 aRAMPS patients and 157 pRAMPS patients were compared.

Figure 2

Kaplan–Meier survival curves of the cases in the aRAMPS group (n = 106) and the pRAMPS group (n = 157) without adrenal gland infiltration. (A) The median overall survival (OS) and estimated 1-, 2-, and 4-year OS rates were 30.3 months and 85.8%, 62.1%, and 34.7%, respectively, in the aRAMPS group and 32.8 months and 84.1%, 63.6%, and 35.1%, respectively, in the pRAMPS group (p = 0.318). (B) The median disease-free survival (DFS) and estimated 1-, 2-, and 4-year DFS rates were 12.0 months and 49.3%, 30.8%, and 22.9%, respectively, in the aRAMPS group and 13.3 months and 51.6%, 31.2%, and 27.3%, respectively, in the pRAMPS group (p = 0.534).