Abstract
Background
Radical antegrade modular pancreatosplenectomy (RAMPS) has oncologic superiority compared
to a standard distal pancreatectomy (DP). For tumors invading into the adrenal gland,
a posterior RAMPS takes the left adrenal gland en bloc with the pancreas specimen. The aim of this analysis is to determine whether addition
of adrenalectomy alters the outcomes of DP.
Methods
The American College of Surgeons (ACS) National Surgical Quality Improvement Program
(NSQIP) Procedure-Targeted Pancreatectomy database was accessed from 2014 to 2019.
Patients with pancreatic ductal adenocarcinoma (PDAC) undergoing posterior RAMPS were
compared to patients having a standard DP. 30-day outcomes were analyzed using multivariable
regression.
Results
3467 PDAC patients underwent DP; 159 (4.6%) also had an adrenalectomy. Posterior RAMPS
patients had higher T stage (T3-4 77% vs. 58%, p < 0.01). On multivariable analysis,
posterior RAMPS patients had worse perioperative outcomes including more transfusions
(OR 2.78, p < 0.01), serious morbidity (OR 1.45, p = 0.04), prolonged hospital stay
(OR 1.36, p < 0.05), and less optimal pancreatic surgery (OR 0.61, p < 0.01).
Conclusion
Radical antegrade modular pancreatosplenectomy with adrenalectomy (posterior RAMPS)
is associated with worse perioperative outcomes compared to a standard distal pancreatectomy.
Improved oncologic outcomes must be weighed against higher perioperative morbidity
when selecting patients for this more extensive surgical resection.
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References
- Radical antegrade modular pancreatosplenectomy.Surgery. May 2003; 133: 521-527https://doi.org/10.1067/msy.2003.146
- Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins.J Am Coll Surg. Feb 2007; 204: 244-249https://doi.org/10.1016/j.jamcollsurg.2006.11.002
- Clinical outcome of RAMPS for left-sided pancreatic ductal adenocarcinoma: a comparison of anterior RAMPS versus posterior RAMPS for patients without periadrenal infiltration.Biomedicines. Sep 22 2021; : 9https://doi.org/10.3390/biomedicines9101291
- Optimal pancreatic surgery: are we making progress in North America?.Ann Surg. 2021; 274 (10 01): e355-e363https://doi.org/10.1097/SLA.0000000000003628
- Neoadjuvant therapy for pancreatic cancer: increased use and improved optimal outcomes.J Am Coll Surg. 2022; 234 (04 01): 436-443https://doi.org/10.1097/XCS.0000000000000095
- Optimal pancreatic surgery: are we making progress in North America?.Ann Surg. 2021; 274: e355-e363https://doi.org/10.1097/SLA.0000000000003628
- The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years after.Surgery. 2017; 161 (03): 584-591https://doi.org/10.1016/j.surg.2016.11.014
- Perioperative allogeneic blood transfusion, the related cytokine response and long-term survival after potentially curative resection of colorectal cancer.Clin Oncol. Feb 2006; 18: 60-66https://doi.org/10.1016/j.clon.2005.08.004
- Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions.Br J Anaesth. May 2013; 110: 690-701https://doi.org/10.1093/bja/aet068
- Perioperative blood transfusion is associated with decreased survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma: a multi-institutional study.J Gastrointest Surg. Sep 2014; 18: 1575-1587https://doi.org/10.1007/s11605-014-2567-4
- Perioperative red blood cell transfusion is associated with poor long-term survival in pancreatic adenocarcinoma.Anticancer Res. 2017; 37: 5863-5870https://doi.org/10.21873/anticanres.12031, 10
- Perioperative blood transfusion and the prognosis of pancreatic cancer surgery: systematic review and meta-analysis.Ann Surg Oncol,. Dec 2015; 22: 4382-4391https://doi.org/10.1245/s10434-015-4823-6
- Impact of operative time on outcomes after pancreatic resection: a risk-adjusted analysis using the American College of surgeons NSQIP database.J Am Coll Surg. 2018; 226 (05) (e3): 844-857https://doi.org/10.1016/j.jamcollsurg.2018.01.004
- Peri-operative blood transfusion and operative time are quality indicators for pancreatoduodenectomy.HPB. Sep 2010; 12: 465-471https://doi.org/10.1111/j.1477-2574.2010.00209.x
- Minimally invasive versus open distal pancreatectomy: an individual patient data meta-analysis of two randomized controlled trials.HPB. 2021; 23 (03): 323-330https://doi.org/10.1016/j.hpb.2020.10.022
- Evaluation of open and minimally invasive adrenalectomy: a systematic review and network meta-analysis.World J Surg. 2017; 41 (11): 2746-2757https://doi.org/10.1007/s00268-017-4095-3
- Adrenalectomy risk score: an original preoperative surgical scoring system to reduce mortality and morbidity after adrenalectomy.Ann Surg. 2019; 270 (11): 813-819https://doi.org/10.1097/SLA.0000000000003526
- Impact of adrenalectomy on morbidity in patients with non-functioning adrenal cortical tumours, mild hypercortisolism and cushing's syndrome as assessed by national and quality registries.World J Surg. 2021; 45 (10): 3099-3107https://doi.org/10.1007/s00268-021-06214-0
- Assessement of postoperative long-term survival quality and complications associated with radical antegrade modular pancreatosplenectomy and distal pancreatectomy: a meta-analysis and systematic review.BMC Surg. Jan 28 2019; 19: 12https://doi.org/10.1186/s12893-019-0476-x
- Is American College of Surgeons NSQIP organ space infection a surrogate for pancreatic fistula?.J Am Coll Surg. Dec 2014; 219: 1111-1116https://doi.org/10.1016/j.jamcollsurg.2014.08.006
- Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure.J Am Coll Surg. Jan 2012; 214: 46-52https://doi.org/10.1016/j.jamcollsurg.2011.10.008
- Single institution results of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of pancreas in 78 patients.J Hepatobiliary Pancreat Sci. Jul 2016; 23: 432-441https://doi.org/10.1002/jhbp.362
- Radical antegrade modular pancreatosplenectomy (RAMPS) versus conventional distal pancreatosplenectomy (CDPS) for left-sided pancreatic ductal adenocarcinoma.Surg Today. Jul 2021; 51: 1126-1134https://doi.org/10.1007/s00595-020-02203-3
- Role of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas.World J Surg. Jan 2014; 38: 186-193https://doi.org/10.1007/s00268-013-2254-8
- Importance of hospital volume in the overall management of pancreatic cancer.Ann Surg. Sep 1998; 228: 429-438https://doi.org/10.1097/00000658-199809000-00016
- Hospital volume and the costs associated with surgery for pancreatic cancer.J Gastrointest Surg. Sep 2017; 21: 1411-1419https://doi.org/10.1007/s11605-017-3479-x
Article info
Publication history
Published online: December 16, 2022
Accepted:
December 9,
2022
Received:
August 15,
2022
Footnotes
Presented at the World Congress of the International Hepato-Pancreato-Biliary Association, New York, NY, March 2022.
Identification
Copyright
© 2022 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.