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Abstract：
BACKGROUND: An artery-first approach for pancreatic cancer (PC) is challenging to perform laparoscopically and is mainly performed using an open approach. The aims of this study were to assess the safety and feasibility of laparoscopic radical antegrade modular pancreatosplenectomy (RAMPS) with an artery-first approach (L-aRAMPS) as compared with open aRAMPS (O-aRAMPS) in resectable PC using matched-pair analysis.
METHODS: Artery-first approach is an early dissection of the superior mesenteric artery (SMA) from behind the pancreas body as the first surgical step. Data on L-aRAMPS and O-aRAMPS, performed between July 2013 and November 2019, were collected retrospectively. Additionally, the spatial characteristics of the splenic artery were analyzed using computed tomography.
RESULTS: Thirty L-aRAMPS and 33 O-aRAMPS for resectable PC were included. After matching, 15 L-aRAMPS were compared with 15 O-aRAMPS. Median intraoperative blood loss and hospital stay were significantly improved in L-aRAMPS compared to O-aRAMPS (30 vs. 220 g, p < 0.001; 12 vs. 16 days, p = 0.049). The overall morbidity was similar in both study groups. The total number of lymph nodes dissected and those harvested from around the SMA and R0 resection was similar in both study groups. We classified the width of the cross section of the pancreas body into three equal parts: the upper, middle, and lower parts of the pancreas; 63% of the splenic artery origin was located in middle and lower parts of the pancreas body.
CONCLUSIONS: L-aRAMPS is technically safe and oncologically feasible to secure favorable surgical outcomes for resectable PC patients.
METHODS: Artery-first approach is an early dissection of the superior mesenteric artery (SMA) from behind the pancreas body as the first surgical step. Data on L-aRAMPS and O-aRAMPS, performed between July 2013 and November 2019, were collected retrospectively. Additionally, the spatial characteristics of the splenic artery were analyzed using computed tomography.
RESULTS: Thirty L-aRAMPS and 33 O-aRAMPS for resectable PC were included. After matching, 15 L-aRAMPS were compared with 15 O-aRAMPS. Median intraoperative blood loss and hospital stay were significantly improved in L-aRAMPS compared to O-aRAMPS (30 vs. 220 g, p < 0.001; 12 vs. 16 days, p = 0.049). The overall morbidity was similar in both study groups. The total number of lymph nodes dissected and those harvested from around the SMA and R0 resection was similar in both study groups. We classified the width of the cross section of the pancreas body into three equal parts: the upper, middle, and lower parts of the pancreas; 63% of the splenic artery origin was located in middle and lower parts of the pancreas body.
CONCLUSIONS: L-aRAMPS is technically safe and oncologically feasible to secure favorable surgical outcomes for resectable PC patients.
摘要：
背景：胰腺癌（PC）的动脉优先方法在腹腔镜下进行具有挑战性，并且主要使用开放方法进行。这项研究的目的是评估采用动脉优先入路（L-aRAMPS）的腹腔镜根治性顺行模块化胰脾切除术（RAMPS）的安全性和可行性，与使用配对对分析的可切除PC中的开放aRAMPS（O-aRAMPS）相比。
方法：动脉优先入路是早期从胰体后面解剖肠系膜上动脉（SMA）的第一个手术步骤。关于L-aRAMPS和O-aRAMPS的数据，在2013年7月至2019年11月期间进行了回顾性收集.此外,使用计算机断层扫描分析脾动脉的空间特征.
结果：包括30个用于可切除PC的L-aRAMPS和33个O-aRAMPS。匹配后,将15个L-aRAMPS与15个O-aRAMPS进行比较。与O-aRAMPS相比，L-aRAMPS的术中出血量中位数和住院时间显着改善（30vs.220g,p<0.001;12vs.16天,p=0.049)。两个研究组的总体发病率相似。在两个研究组中，从SMA和R0切除术周围解剖的淋巴结总数和收获的淋巴结总数相似。我们将胰体横截面的宽度分为三个相等的部分：上部，中间,和胰腺的下部；63％的脾动脉起源位于胰体的中下部。
结论：L-aRAMPS在技术上是安全的，在肿瘤学上是可行的，可以确保可切除的PC患者获得良好的手术结果。
方法：动脉优先入路是早期从胰体后面解剖肠系膜上动脉（SMA）的第一个手术步骤。关于L-aRAMPS和O-aRAMPS的数据，在2013年7月至2019年11月期间进行了回顾性收集.此外,使用计算机断层扫描分析脾动脉的空间特征.
结果：包括30个用于可切除PC的L-aRAMPS和33个O-aRAMPS。匹配后,将15个L-aRAMPS与15个O-aRAMPS进行比较。与O-aRAMPS相比，L-aRAMPS的术中出血量中位数和住院时间显着改善（30vs.220g,p<0.001;12vs.16天,p=0.049)。两个研究组的总体发病率相似。在两个研究组中，从SMA和R0切除术周围解剖的淋巴结总数和收获的淋巴结总数相似。我们将胰体横截面的宽度分为三个相等的部分：上部，中间,和胰腺的下部；63％的脾动脉起源位于胰体的中下部。
结论：L-aRAMPS在技术上是安全的，在肿瘤学上是可行的，可以确保可切除的PC患者获得良好的手术结果。
