Background : Radical antegrade modular pancreatosplenectomy (RAMPS) is a modification of distal pancreatectomy for complete N1 lymph node dissection and adequate posterior margin. The ultimate goal is an improvement of survival in left-side pancreatic cancer. However, the survival benefit of the RAMPS is unclear. Aim of this study is to evaluate the survival benefit of RAMPS, compared to conventional distal pancreatectomy (cDP).

Methods : A retrospective analysis of 333 patients who underwent RAMPS or cDP for left-sided pancreatic cancer at Chonnam National University Hospital, Chonnam National University Hwasun Hospital, Seoul Samsung Medical center, Gangbuk Samsung Medical center, and Ehwa University Mokdong Hospital from 2010 to 2019 was performed. After propensity score matching, we compared survival and operative outcomes, including blood loss, hospital stay, and morbidity between RAMPS and cDP. Prognostic factors were also analyzed.

Results : After 1:1 PSM, ninety-nine patients were included in each group. Retrieved lymph nodes count was higher in RAMPS (median, 15 vs. 10, p<0.001) compared to cDP. No significant differences in R0 resection rate, blood loss, hospital stay, and morbidity were observed between both groups. Overall survival (72.9 months vs 69.0 months, P=0.760), and disease-free survival (36.3 months vs 31.5 months, P=0.743) was comparable in both groups. In multivariate analysis, independent significant prognostic factors were poorly or undifferentiated histologic differentiation (HR=3.090, p=0.004), N-stage and adjuvant treatment (HR=2.183, p=0.001) for overall survival.

Conclusions : RAMPS was associated with high retrieved lymph node count, however, it did not affect to overall and disease-free survival. Histological differentiation, N-stage and adjuvant treatment were independent significant prognostic factors rather than operation type.