Laparoscopic versus open radical antegrade modular pancreatosplenectomy with artery-first approach in pancreatic cancer

Langenbecks Arch Surg. 2020 Aug;405(5):647-656. doi: 10.1007/s00423-020-01887-y. Epub 2020 Jun 10.


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.

Conclusion: L-aRAMPS is technically safe and oncologically feasible to secure favorable surgical outcomes for resectable PC patients.

Keywords: Artery-first approach; Laparoscopic radical antegrade modular pancreatosplenectomy; Pancreatic cancer; Propensity score matching; Splenic artery; Superior mesenteric artery.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Celiac Artery / surgery
  • Female
  • Humans
  • Laparoscopy / methods*
  • Male
  • Margins of Excision
  • Matched-Pair Analysis
  • Mesenteric Artery, Superior / surgery
  • Mesenteric Veins / surgery
  • Neoplasm Staging
  • Pancreatectomy / methods*
  • Pancreatic Neoplasms / diagnostic imaging
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / surgery*
  • Propensity Score
  • Splenectomy / methods*
  • Splenic Artery / surgery