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Minimally Invasive Versus Open Radical Antegrade Modular Pancreaticosplenectomy (RAMPS): A Multicenter Cohort Study
Lukas Heinrich Poelsler1, Ruben Bellotti1, Florian Primavesi1,2
1Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Minimally invasive Radical Antegrade Modular Pancreatosplenectomy (MI-RAMPS) offers oncologic outcomes equivalent to open RAMPS for pancreatic cancer. This approach shows similar survival and complication rates, with potential benefits in reduced hospital stay and increased adjuvant chemotherapy receipt.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Pancreatic Surgery
Background:
- Radical Antegrade Modular Pancreatosplenectomy (RAMPS) is a key procedure for left-sided pancreatic ductal adenocarcinoma (PDAC).
- The debate continues regarding the optimal surgical approach: open versus minimally invasive (MI) RAMPS.
- Comparative data on oncologic and early postoperative outcomes between MI-RAMPS and open RAMPS are limited.
Purpose of the Study:
- To compare the oncologic radicality and early postoperative outcomes of minimally invasive (MI) versus open Radical Antegrade Modular Pancreatosplenectomy (RAMPS).
- To evaluate differences in resection margin status, lymph node yield, survival, and complications between MI-RAMPS and open RAMPS for pancreatic cancer.
Main Methods:
- A multicenter retrospective cohort study involving 57 patients undergoing RAMPS between 2016 and 2023.
- Patients were stratified into minimally invasive (MI) and open surgical approach groups.
- Primary endpoints included R0 resection rates and lymph node yield; secondary outcomes assessed survival and postoperative complications.
Main Results:
- Oncologic outcomes were comparable: R0 resection rates (92.9% MI vs. 85% open) and lymph node yield (16 vs. 19) were similar between MI-RAMPS and open RAMPS.
- Two-year overall survival rates were also equivalent (71.6% MI vs. 66.4% open).
- Postoperative complications and major adverse events (Clavien-Dindo ≥ IIIa) did not significantly differ; MI-RAMPS showed trends towards shorter length of stay and increased adjuvant chemotherapy receipt.
Conclusions:
- Minimally invasive RAMPS (MI-RAMPS) achieves oncologic equivalence to the open approach for left-sided pancreatic cancer.
- Early postoperative outcomes, including survival and complication rates, are comparable between MI-RAMPS and open RAMPS.
- MI-RAMPS may offer advantages such as reduced length of hospital stay and a higher likelihood of receiving adjuvant chemotherapy.
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