Laparoscopic Posterior Radical Antegrade Modular Pancreatosplenectomy for Distal Pancreatic Carcinoma

Summary

Laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) is currently considered technically safe and feasible. However, due to technical challenges and a lack of supporting evidence for widespread clinical applications, only a limited number of institutions are currently conducting L-RAMPS. This article aims to provide detailed techniques for laparoscopic posterior radical antegrade modular pancreatosplenectomy.

Abstract

Distal pancreatic carcinoma is a highly malignant tumor with strong invasiveness, often growing to the edge of the pancreas and penetrating the pancreatic capsule to infiltrate surrounding tissues. In conventional distal pancreatosplenectomy (DPS), tumor cells are prone to spread along the direction of blood and lymphatic reflux due to surgical compression. Additionally, inflammation makes it challenging to achieve R0 resection, leading to a lower patient survival rate. To address these limitations, radical antegrade modular pancreatosplenectomy (RAMPS) was developed, emphasizing deeper excision, including the left anterior renal fascia, the left anterior renal adipose sac, and even the left adrenal gland, to improve the R0 resection rate. With the advancement of minimally invasive surgical techniques, laparoscopic RAMPS (L-RAMPS) is being considered technically safe and feasible in oncology. However, due to technical difficulties and a lack of supporting evidence for clinical application, only a few institutions are currently conducting L-RAMPS. In this context, this article presents detailed techniques for laparoscopic posterior radical antegrade modular pancreatosplenectomy (L-pRAMPS), offering promise for future clinical applications.

Introduction

Conventional distal pancreatosplenectomy (DPS) has traditionally been the standard surgical procedure for distal pancreatic carcinoma^1,2. Distal pancreatic carcinoma is a highly invasive tumor that easily infiltrates into retroperitoneal tissues. Simultaneously, pancreatic cancer is often accompanied by chronic pancreatitis, making the boundary between the pancreas and adjacent tissues unclear. Consequently, during conventional DPS, there is a risk of tumor cells spreading along the direction of blood circulation and lymphatic return. In addition to the inherent inflammation associated with pancreatic cancer, ....

Protocol

The surgical procedure was approved by the institutional review board at The First Affiliated Hospital of Jinan University. The patient, a 58-year-old female, was admitted with a chief complaint of "abdominal pain for 2 months." A computed tomography (CT) scan conducted at an external hospital revealed a space-occupying lesion in the distal pancreas, raising concerns about the possibility of pancreatic carcinoma. Before the surgery, the patient provided written informed consent. The surgical tools and equipment used for this procedure are listed in the Table of Materials.

1. Preoperative preparation

Results

The surgery proceeded smoothly, and the intraoperative rapid frozen pathological examination indicated the absence of cancer at the incisal margin of the pancreas. Throughout the surgery, the patient's vital signs remained stable, and the anesthesia was effective. The operation duration was 150 min, with an intraoperative blood loss of 80 mL. Anal exhaust occurred 32 h postoperatively. There were no complications such as abdominal hemorrhage, pancreatic leakage, abdominal infection, or incision infection. The postoperati.......

Discussion

DPS has been widely used as the standard radical surgery for distal pancreatic carcinoma^1,2. However, due to the highly invasive nature of pancreatic cancer, it is easy for the tumor to grow to the edge of the pancreas and even break through the surface of the pancreas. Meanwhile, accompanying chronic pancreatitis makes the boundary between the pancreas and the surrounding tissues unclear. Therefore, it is difficult to achieve R0 resection during conventional sur.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
10-mm trocar	Xiamen Surgaid Medical Device Co., LTD	NGCS 100-1-10	Sterile, ethylene oxide sterilized, disposable
12-mm trocar	Xiamen Surgaid Medical Device Co., LTD	NGCS 100-1-12	Sterile, ethylene oxide sterilized, disposable
5-mm trocar	Xiamen Surgaid Medical Device Co., LTD	NGCS 100-1-5	Sterile, ethylene oxide sterilized, disposable
Hem-o-lok	America Teleflex Medical Technology Co., LTD	544240	Sterile, ethylene oxide sterilized, disposable
Linear stapling device	America Ethicon Medical Technology Co., LTD	PSEE60A	Sterile, ethylene oxide sterilized, disposable
Pneumoperitoneum needle	Xiamen Surgaid Medical Device Co., LTD	NGCS 100-1	Sterile, ethylene oxide sterilized, disposable
Suction and irrigation tube	Tonglu Hengfeng Medical Device Co., LTD	HF6518.035	Sterile,dry heat sterilized, reusable
Ultrasounic-harmonic scalpel	Chongqing Maikewei Medical Technology Co., LTD	QUHS36S	Sterile, ethylene oxide sterilized, disposable