title: The short- and long-term outcomes of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas.
abstract: BACKGROUND
  Radical antegrade modular pancreatosplenectomy (RAMPS) is a relatively new modification of the standard distal pancreatosplenectomy. In this method, dissection proceeds from right-to-left to achieve negative posterior resection margins. However, short-term and long-term outcomes of RAMPS for pancreatic cancer have not yet been clarified. The aim of this study is to evaluate short-term and long-term outcomes in the patients who have undergone RAMPS.
  
  
  METHODS
  Consecutive 49 patients were selected from the retrospective database of the Kanagawa Cancer Center from 2000 to 2014. Data from the operative notes, pathology reports, postoperative data, and outpatient data (recurrence and survival) were entered into the database.
  
  
  RESULTS
  All patients were undergone anterior RAMPS. The median operation time was 278 min (range from 140 to 625 mins). The median blood loss in operation was 850 ml (range from 60 to 2790 ml). The overall incidence of morbidity was 51.4% and the incidence of mortality was 0%. Forty-one patients (83.7%) had negative resection margins. The mean number of lymph nodes harvested was 15 and 27 patients had lymph node metastasis. After the median follow-up period was 41.1 months, 1-year and 3-year overall survival rates were 84.1 and 38.6%, respectively. Median overall survival was 22.6 months.
  
  
  CONCLUSIONS
  The present study results suggested that RAMPS procedure might be safe and feasible without an increase in morbidity and morbidity and have survival benefit compared with standard DP.
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan. m-murakawa@kcch.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Murakawa
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan. t-aoyama@lilac.plala.or.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan. asari@kcch.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Asari
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan. ykatayama@kcch.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Katayama
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan. k-yamaoku@kcch.jp.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yamaoku
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan. amanex2009@gmail.com.
authors.forename: Amane
authors.initials: A
authors.lastname: Kanazawa
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan. a-higuchi@kcch.jp.
authors.forename: Akio
authors.initials: A
authors.lastname: Higuchi
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan. shiozawam@kcch.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Shiozawa
authors.affiliation: Department of Gastrointestinal medicine, Kanagawa Cancer Center, Yokohama, Japan. kobayashis@kcch.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Gastrointestinal medicine, Kanagawa Cancer Center, Yokohama, Japan. uenom@kcch.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ueno
authors.affiliation: Department of Gastrointestinal medicine, Kanagawa Cancer Center, Yokohama, Japan. m-morimoto@kcch.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Morimoto
authors.affiliation: Department of Surgery, Yokohama City University, Yokohama, Japan. naoto_y@yokohama-cu.ac.jp.
authors.forename: Naoto
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan. yoshikawat@kcch.jp.
authors.forename: Takaki
authors.initials: T
authors.lastname: Yoshikawa
authors.affiliation: Department of Surgery, Yokohama City University, Yokohama, Japan. rino@med.yokohama-cu.ac.jp.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.affiliation: Department of Surgery, Yokohama City University, Yokohama, Japan. mmasuda@yokohama-cu.ac.jp.
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan. morinagas@kcch.jp.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Morinaga
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome