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27.02.2019 | How-I-Do-It article | Ausgabe 2/2019

Langenbeck's Archives of Surgery 2/2019

Left kidney mobilization technique during radical antegrade modular pancreatosplenectomy (RAMPS)

Zeitschrift:
Langenbeck's Archives of Surgery > Ausgabe 2/2019
Autoren:
Genki Watanabe, Hiromichi Ito, Takafumi Sato, Yoshihiro Ono, Yoshihiro Mise, Yosuke Inoue, Yu Takahashi, Akio Saiura
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00423-019-01767-0) contains supplementary material, which is available to authorized users.
This manuscript was presented in part at the AHPBA 2017 Annual Meeting March 29–April 2, Miami Beach, FL

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Abstract

Purpose

Radical antegrade modular pancreatosplenectomy (RAMPS) has been accepted as a standard operation for distal pancreatic cancer. While enbloc retroperitoneal dissection in the “medial to lateral” direction is one of the most important steps in this oncologic procedure, it is technically challenging due to the depth of organs under the left costal margin, and poor exposure of the resecting organs in this area will increase the risk of incomplete oncologic dissection.

Methods

To improve exposure of the left upper quadrant organs, left kidney was completely mobilized during RAMPS, and all the left upper quadrant organs were elevated and medialized by lap sponges packed in the retro-renal space. The operative and oncologic outcomes for patients who underwent our modified RAMPS with left kidney mobilization were evaluated.

Results

One hundred and forty-four patients with distal pancreatic cancer underwent this procedure from 2005 through 2016. The median operation time was 310 min (range, 132–899), and blood loss was 440 ml (25–2430). There was no complication associated to left kidney mobilization. The median number of harvested lymph nodes was 27 (3–87). While 77% of the tumors had microscopic retroperitoneal invasion, 96% of patients achieved negative retroperitoneal margin.

Conclusions

Left kidney mobilization is useful for safe and oncologically sound lateral retroperitoneal dissection during RAMPS for distal pancreatic cancer.

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