Minimally invasive radical pancreatectomy for left-sided pancreatic cancer: Current status and future perspectives

Figure 2 Determining the extent of minimally invasive radical antegrade modular pancreatosplenectomy. The dotted line shows the technical feasibility of bloodless and margin-negative radical antegrade modular pancreatosplenectomy (RAMPS) by a minimally invasive approach, and the solid line represents the biological aggressiveness of tumors, according to the appropriate mode of RAMPS for margin-negative resection. Tentatively, minimally invasive anterior RAMPS is thought to represent a generally acceptable surgical extent for bloodless and margin-negative resections. Oncologically safe posterior RAMPS 1 and 2 might be difficult to perform using a minimally invasive approach. Note the marginal zone of (B). Only a few expert laparoscopic surgeons can be fully responsible for this region. Future directions include widening the area of (B) by means of technical evolution (shifting of the dotted line to the left) and improving early tumor detection (attenuating the slope of solid line). MIS: Minimally invasive surgery.