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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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.
