Evaluating the efficacy of laparoscopic radical antegrade modular pancreatosplenectomy in selected early-stage left-sided pancreatic cancer: a propensity score matching study

Zheng Li ^1,2,3,4, Wenyan Xu ^1,2,3,4, Ting Wang ^1,2,3,4

¹Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, China.
²Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
³Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China.
⁴Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.
⁵Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, China. liuwensheng@fudanpci.org.
⁶Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. liuwensheng@fudanpci.org.
⁷Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China. liuwensheng@fudanpci.org.
⁸Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China. liuwensheng@fudanpci.org.
⁹Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, China. yuxianjun@fudanpci.org.
¹⁰Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. yuxianjun@fudanpci.org.
¹¹Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China. yuxianjun@fudanpci.org.
¹²Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China. yuxianjun@fudanpci.org.
¹³Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, China. xuxiaowu@fudanpci.org.
¹⁴Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. xuxiaowu@fudanpci.org.
¹⁵Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China. xuxiaowu@fudanpci.org.
¹⁶Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China. xuxiaowu@fudanpci.org.

⁰Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, China.

Surgical Endoscopy +

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May 15, 2024

View abstract on PubMed

Summary

Laparoscopic radical antegrade modular pancreatosplenectomy (LRAMPS) did not offer oncological advantages over laparoscopic distal pancreatosplenectomy (LDP) for early-stage pancreatic cancer. LRAMPS increased operative time and complications, impacting adjuvant chemotherapy completion.

Area Of Science

Surgical Oncology
Gastroenterology
Minimally Invasive Surgery

Background

Laparoscopic radical pancreatectomy is a safe approach for resectable pancreatic cancer.
The optimal extent of resection for early-stage tumors is debated.

Purpose Of The Study

To compare the oncological and clinical outcomes of laparoscopic radical antegrade modular pancreatosplenectomy (LRAMPS) versus laparoscopic distal pancreatosplenectomy (LDP) for left-sided pancreatic cancer.
To evaluate the impact of surgical approach on adjuvant chemotherapy completion.

Main Methods

A retrospective review of consecutive patients with left-sided pancreatic cancer undergoing LRAMPS (n=54) or LDP (n=131) between October 2020 and December 2022.
Preoperative radiological criteria included tumor diameter ≤4 cm, distance ≥1 cm from celiac trunk, and no invasion of the retroperitoneal fascia.
1:1 propensity score matching was used for comparison (n=54 per group).

Main Results

LRAMPS involved longer operation times and higher intraoperative bleeding compared to LDP.
While LRAMPS harvested more lymph nodes, oncological outcomes (margin status, lymph node positivity) and recurrence patterns were similar.
Postoperative complications were comparable, but LRAMPS led to increased drainage, delayed diet recovery, and more frequent bowel movements.
Adjuvant chemotherapy completion rates were significantly lower after LRAMPS.

Conclusions

LRAMPS did not demonstrate oncological superiority over LDP for selected left-sided pancreatic cancers.
Increased operative time, bleeding, and postoperative gastrointestinal issues with LRAMPS may hinder adjuvant chemotherapy completion.
The findings suggest LDP may be a more favorable approach considering the overall treatment pathway and potential for adjuvant therapy.

Keywords:

Early-stage tumor Laparoscopic distal pancreatosplecnectomy Laparoscopic radical antegrade modular pancreatosplenectomy Left-sided pancreatic cancer Oncologic prognosis Surgical complication