| International Session (Symposium) 4 (JSGS・JSH) |
| Fri. November 2nd 9:40 - 12:00 Room 12: Kobe International Conference Center Main Hall |
| Laparoscopic Radical Antegrade Modular Pancreatosplenectomy with Superior Mesenteric Artery-First Approach in Pancreatic Cancer | |||
| Yasunari Kawabata1, Hikota Hayashi1, Yoshitsugu Tajima1 | |||
| 1The Department of Digestive and General Surgery, Shimane University Faculty of Medicine | |||
|
|||
|
|||
| Background: Radical antegrade modular pancreatosplenectomy with the artery-first approach (a-RAMPS) for pancreatic cancer can secure negative surgical margins before reaching the point of no return and favorable outcomes. The concept of a-RAMPS is an early dissection of the SMA and celiac axis from behind the body of the pancreas as the first step of the operation. The aim of this study was to assess the feasibility of laparoscopic a-RAMPS (L-aRAMPS) in pancreas cancer patients. Methods: Between July 2013 and February 2018, a total of 42 consecutive patients underwent a-RAMPS for cancer of the body or tail of the pancreas. The operative results and postoperative short-term outcomes were compared between conventional open a-RAMPS (O-aRAMPS) and L-aRAMPS. Results: Thirty-four patients underwent O-aRAMPS and 8 patients received L-aRAMPS. Intraoperative blood loss was 30g (range 5-150) in L-aRAMPS and it was significantly low compared to O-aRAMPS (p=0.007). The overall morbidity including the postoperative pancreatic fistula and delayed gastric emptying, duration of drain placement, time to resumption of oral intake, and hospital stay were similar in the two study groups. Total number of dissected lymph nodes in L-aRAMPS was equivalent to O-aRAMPS. Although tumor stage was similar in the two study groups, the R0 resection was achieved in all patients in L-aRAMPS and microscopic positive resection margin (R1) was evident in 2 (5.9%) patients in O-aRAMPS. The overall survival rate was 100% at 1 year and the 1-year disease-free survival rate was 87% in L-aRAMPS, with the median follow-up period of 7.4 months. Conclusions: L-aRAMPS was technically safe and oncologically feasible. |
|||
|
Index Term 1: laparoscopic RAMPS Index Term 2: SMA-first approach |
|||
| Page Top | |||