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

Table 1 Recent studies on minimally invasive radical antegrade modular pancreatosplenectomy and open distal pancreatectomy in left-sided pancreatic cancer n (%)

Characterisc	Minimally invasive distal pancreatosplenectomy					Open distal pancreatosplenectomy
	Fernández-Cruz et al[12]	Song et al[37]	Choi et al[36,38]	Magge et al[40]	Marangos et al[41]	Kanda et al[48]	Kooby et al[23]	Kang et al[14]	Mitchem et al[22]	Okada et al[50]
Surgical technique	RAMPS-based	RAMPS- based	RAMPS- based	RAMPS-based	Conventional technique-based	NA	NA	Conventional technique-based	RAMPS-based	Standard DP
Indication	Anatomic dissection No combined resection	No distant metastasis Not locally advanced	Relatively pancreas-confined, intact fascia layer, apart from celiac axis	Allegedly the same as open surgery, even when allowing adjacent organ combined resection	Apparently the same as open surgery, even when allowing adjacent organ combined resection	Resectable, no distal metastasis, no peritoneal seeding, no major vascular invasion	NA	Resectable, no distal metastasis, no peritoneal seeding, no major vascular invasion	Resectable, no distant metastasis, no peritoneal seeding	Resectable, not invading major vessel
Patients (n)	10	24	9	28	21	51	70	27	47	36
Age (yr)	NA	NA	64.8 (54-76)	67 (60-75)	63.1 (49-83)	62.7 (38-79)	65.9 ± 11.1	60.5 (47-75)	64.5 ± 10.3	68
Gender (male/female)	NA	16/8	5/4	9/19	6/15	34/17	27/43	20/7	20/27	23/13
Tumor size (cm)	NA	2.6 (1.4-10)	2.5 (1.2-6)	3.0 (2.2-3.6)	4.8 (1.0-10)	7 (< 2 cm) 44 (> 2 cm)	3.5 ± 1.4	3.9 (2.5-5.3)	4.4 ± 2.1	NA
pT stage (T1/T2/T3/T4)	NA	NA	0/0/9/0	NA	NA	2/5/20/24/01	NA	1/4/20/2	1/4/41/1	1/2/15/17/0/1/1
Retrieved LNs	14.5 (6-20)	10.3 ± 8.6	10.8 (2-23)	11 (8-20)	7.4(0-26)	NA	12.3 ± 8.3	11.3 (5-18)	18.0 ± 11.7	NA
pN stage (N0/N1)	5/5	NA	2/7	12/16	14/9	25/26	NA	15/12	26/21	19/17
R0(%)/R1/R2	9 (90)/1/0	22 (91.7)/2/0	9 (100)/0/0	24 (86)/4 (14)/0	19 (90.5)/2/0	38 (74.5)/13	46/24	3/4/2020	81%/19%/0%	29 (80.5%)/6/1
Operation time (min)	320 (280-330)	225 (95-360)	368.3 (180-700)	260 (220-340)	NA	NA	216 ± 69	274 (97-453)	243.6 ± 93.5	203 (128-276)
Blood loss	720 (300-1300)	NA	360.1 (trace-1350)	200 (150-300)	NA	NA	751 ± 853	643.3 (100-1200)	744.3 ± 570.4	700 (10-2850)
Hospital stay (d)	8 (7-11)	9.5 (5-22)	9 (4-16)	6 (4-6)	5	NA	9.4 ± 4.7	21.2 (7-24)	11.3 ± 6.8	NA
Adjuvant chemotherapy	10 (100)	17 (70.8)	9 (100)	17 (100)	NA	NA	45 (64)	NA	NA	NA
Follow-up period (mo)	NA	9.95 (1.3-48.5)	20.7 (5.1-45.9)	NA	21.1 (0.5-108)	17.1	10	NA	26.4	25
Oncologic outcome	Median survival 14 mo	2-yr overall survival, 85.2%	2-yr disease free survival, 83.3%	NA	Median survival 19 mo	1, 3, 5-yr overall survival rate, 57.2%, 12.4%, 6.2%	Overall survival 16 mo	Median survival 27.9 mo, 5-yr survival, 28.9%	Median survival 25.9 mo, 5-yr survival, 30.4%	Median survival 32 mo, 2-yr survival 52%

Data are confined to pancreatic ductal adenocarcinoma alone.

¹UICC Cancer Staging System. NA: Not available; RAMPS: Radical antegrade modular pancreatosplenectomy.