No-touch pancreatectomy and radical antegrade modular pancreatosplenectomy: a systematic review

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Aim. To summarize the data of «no-touch isolation technique» (NIT) for pancreatoduodenectomy and radical antegrade modular pancreato-splenectomy (RAMPS) for pancreatic malignancies. Material and methods. We looked through Pubmed and Cochrane databases for scientific papers published from January 2000 until September 2014. Results. Eight studies were included. There were 7 retrospective cohort studies and one randomized controlled trial (RCT). Mean operation time and blood loss were 267 min (198—386 min) and 132 ml (331—744 ml) respectively. Mean morbidity rate was 35% (17—58%). There was no 30-day mortality. Mean incidence of R0-resection varied from 50% to 97% with average value 84%. Median survival was reported in 3 studies (17, 18 and 26 months). Five-year actuarial overall survival was reported in 4 studies (31, 36, 40 and 53%). Conclusion. Positive results of NIT and RAMPS might justify further evaluation of the method in pancreatic cancer. Prospective randomized controlled trials needs to be done to demonstrate the oncological value of this novel surgical technique.

Keywords:

pancreatic ductal adenocarcinoma

no-touch isolation tehnique

radical antegrade modular pancreatosplenectomy

Authors:

Lyadov V.K.

Medical and Rehabilitation Center under the Ministry of Health of Russian Federation, Moscow, Russia

Milovanov V.V.

Tambovskiĭ oblastnoĭ onkologicheskiĭ klinicheskiĭ dispanser

List of references:

Hishinuma S, Ogata Y, Tomikawa M, Ozawa I, Hirabayashi K, Igarashi S. Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract. 2006;10(4):511-518. doi: 10.1016/j.gassur.2005.09.016
Schnelldorfer T, Ware AL, Sarr MG, Smyrk TC, Zhang L, Qin R, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Annals of surgery. 2008;247(3):456-462. doi: 10.1097/SLA.0b013e3181613142
Richter A, Niedergethmann M, Sturm JW, Lorenz D, Post S, Trede M. Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World Journal of Surgery. 2003;27(3):324-329. doi: 10.1007/s00268-002-6659-z
Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. The British Journal of Surgery. 2004;91(5):586-594. doi: 10.1002/bjs.4484
Esposito I, Kleeff J, Bergmann F, Reiser C, Herpel E, Friess H, et al. Most pancreatic cancer resections are R1 resections. Annals of Surgical Oncology. 2008;15(6):1651-1660. doi: 10.1245/s10434-008-9839-8
Verbeke CS, Leitch D, Menon KV, McMahon MJ, Guillou PJ, Anthoney A. Redefining the R1 resection in pancreatic cancer. The British Journal of Surgery. 2006;93(10):1232-1237. doi: 10.1002/bjs.5397
Bosch B, Guller U, Schnider A, Maurer R, Harder F, Metzger U, et al. Perioperative detection of disseminated tumour cells is an independent prognostic factor in patients with colorectal cancer. The British Journal of Surgery. 2003;90(7):882-888. doi: 10.1002/bjs.4129
Hirota M, Shimada S, Yamamoto K, Tanaka E, Sugita H, Egami H, et al. Pancreatectomy using the no-touch isolation technique followed by extensive intraoperative peritoneal lavage to prevent cancer cell dissemination: a pilot study. Journal of the pancreas. 2005;6(2):143-151.
Koch M, Kienle P, Hinz U, Antolovic D, Schmidt J, Herfarth C, et al. Detection of hematogenous tumor cell dissemination predicts tumor relapse in patients undergoing surgical resection of colorectal liver metastases. Annals of Surgery. 2005;241(2):199-205.
Lianidou ES, Markou A. Circulating tumor cells as emerging tumor biomarkers in breast cancer. Clinical chemistry and laboratory medicine. 2011;49(10):1579-1590. doi: 10.1515/CCLM.2011.628
Hirota M, Ogawa M. No-touch pancreatectomy for invasive ductal carcinoma of the pancreas. Journal of the pancreas. 2014;15(3):243-249. doi: 10.6092/1590-8577/2502
Mitchem JB, Hamilton N, Gao F, Hawkins WG, Linehan DC, Strasberg SM. Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. Journal of the American College of Surgeons. 2012;214(1):46-52. doi: 10.1016/j.jamcollsurg.2011.10.008
Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003;133(5):521-527. doi: 10.1067/msy.2003.146
Kitagawa H, Tajima H, Nakagawara H, Makino I, Miyashita T, Terakawa H, et al. A modification of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the left pancreas: significance of en bloc resection including the anterior renal fascia. World Journal of Surgery. 2014;38(9):2448-2454. doi: 10.1007/s00268-014-2572-5
Takaori KKM, editor. Medial-approach right pancreatectomy: surgical technique and preliminary results. 46th Annual Meeting of the Pancreas Club. 2012.
Chang YR, Han SS, Park SJ, Lee SD, Yoo TS, Kim YK, et al. Surgical outcome of pancreatic cancer using radical antegrade modular pancreatosplenectomy procedure. World Journal of Gastroenterology. 2012;18(39):5595-5600. doi: 10.3748/wjg.v18.i39.5595
Gall TM, Jacob J, Frampton AE, Krell J, Kyriakides C, Castellano L, et al. Reduced dissemination of circulating tumor cells with no-touch isolation surgical technique in patients with pancreatic cancer. JAMA Surgery. 2014;149(5):482-485. doi: 10.1001/jamasurg.2013.3643
Park HJ, You DD, Choi DW, Heo JS, Choi SH. Role of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. World Journal of Surgery. 2014;38(1):186-193. doi: 10.1007/s00268-013-2254-8
Buchler MW, Wagner M, Schmied BM, Uhl W, Friess H, Z'Graggen K. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Archives of Surgery. 2003;138(12):1310-1314. doi: 10.1001/archsurg.138.12.1310
Diener MK, Fitzmaurice C, Schwarzer G, Seiler CM, Antes G, Knaebel HP, et al. Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. The Cochrane database of systematic reviews. 2011(5):CD006053. doi: 10.1002/14651858.CD006053.pub4
Stojadinovic A, Brooks A, Hoos A, Jaques DP, Conlon KC, Brennan MF. An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma. Journal of the American College of Surgeons. 2003;196(6):954-964. doi: 10.1016/S1072-7515(03)00010-3
Strasberg SM, Drebin JA, Soper NJ. Evolution and current status of the Whipple procedure: an update for gastroenterologists. Gastroenterology. 1997;113(3):983-994.
Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract. 2006;10(9):1199-1210. doi: 10.1016/j.gassur.2006.08.018
Aldridge MC, Williamson RC. Distal pancreatectomy with and without splenectomy. The British journal of surgery. 1991;78(8):976-979.
Sheehan MK, Beck K, Creech S, Pickleman J, Aranha GV. Distal pancreatectomy: does the method of closure influence fistula formation? The American Surgeon. 2002;68(3):264-267.
Iqbal N, Lovegrove RE, Tilney HS, Abraham AT, Bhattacharya S, Tekkis PP, et al. A comparison of pancreaticoduodenectomy with pylorus preserving pancreaticoduodenectomy: a meta-analysis of 2822 patients. European journal of surgical oncology. The journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2008;34(11):1237-1245. doi: 10.1016/j.ejso.2007.12.004
Khoja L, Backen A, Sloane R, Menasce L, Ryder D, Krebs M, et al. A pilot study to explore circulating tumour cells in pancreatic cancer as a novel biomarker. British Journal of Cancer. 2012;106(3):508-516. doi: 10.1038/bjc.2011.545
Hirota M, Kanemitsu K, Takamori H, Chikamoto A, Tanaka H, Sugita H, et al. Pancreatoduodenectomy using a no-touch isolation technique. American Journal of Surgery. 2010;199(5):65-68. doi: 10.1016/j.amjsurg.2008.06.035

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