title: Surgical outcome of pancreatic cancer using radical antegrade modular pancreatosplenectomy procedure.
abstract: OBJECTIVE
  To evaluate the surgical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic cancer.
  
  
  METHODS
  Twenty-four patients underwent RAMPS with curative intent between January 2005 and June 2009 at the National Cancer Center, South Korea. Clinicopathologic data, including age, sex, operative findings, pathologic results, adjuvant therapy, postoperative clinical course and follow-up data were retrospectively collected and analyzed for this study.
  
  
  RESULTS
  Twenty-one patients (87.5%) underwent distal pancreatectomy and 3 patients (12.5%) underwent total pancreatectomy using RAMPS. Nine patients (37.5%) underwent combined vessel resection, including 8 superior mesenteric-portal vein resections and 1 celiac axis resection. Two patients (8.3%) underwent combined resection of other organs, including the colon, stomach or duodenum. Negative tangential margins were achieved in 22 patients (91.7%). The mean tumor diameter for all patients was 4.09 ± 2.15 cm. The 2 patients with positive margins had a mean diameter of 7.25 cm. The mean number of retrieved lymph nodes was 20.92 ± 11.24 and the node positivity rate was 70.8%. The median survival of the 24 patients was 18.23 ± 6.02 mo. Patients with negative margins had a median survival of 21.80 ± 5.30 mo and those with positive margins had a median survival of 6.47 mo (P = 0.021). Nine patients (37.5%) had postoperative complications, but there were no postoperative mortalities. Pancreatic fistula occurred in 4 patients (16.7%): 2 patients had a grade A fistula and 2 had a grade B fistula. On univariate analysis, histologic grade, positive tangential margin, pancreatic fistula and adjuvant therapy were significant prognostic factors for survival.
  
  
  CONCLUSIONS
  RAMPS is a feasible procedure for achieving negative tangential margins in patients with carcinoma of the body and tail of the pancreas.
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul , South Korea.
authors.forename: Ye Rim
authors.initials: YR
authors.lastname: Chang
authors.forename: Sung-Sik
authors.initials: SS
authors.lastname: Han
authors.forename: Sang-Jae
authors.initials: SJ
authors.lastname: Park
authors.forename: Seung Duk
authors.initials: SD
authors.lastname: Lee
authors.forename: Tae Suk
authors.initials: TS
authors.lastname: Yoo
authors.forename: Young-Kyu
authors.initials: YK
authors.lastname: Kim
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Sang Myung
authors.initials: SM
authors.lastname: Woo
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Lee
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Hong
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D013156:Splenectomy
keywords: Carcinoma; Pancreas; Radical antegrade modular pancreatosplenectomy; Surgical resection; Survival