{
    "abstract": "'Shoulder' pancreatic cancer is a challenging situation owing to its close proximity to the branches of the celiac artery and portal vein (PV). A pioneering study demonstrated the feasibility of retrograde artery first approach pancreatosplenectomy (RAFAPS) in treating 'shoulder' pancreatic cancer. However, comparative studies on this topic are lacking.\nIn this single-centre cohort study, we retrospectively enrolled consecutive 'shoulder' pancreatic cancer cases from September 2019 to May 2023. Based on propensity score-matching analysis, we compared the safety and short-term oncological outcomes between RAFAPS and radical antegrade modular pancreatosplenectomy (RAMPS) for 'shoulder' pancreatic cancers. The primary outcome was a negative retroperitoneal margin rate.\nIn total, 135 (17.0%) 'shoulder' pancreatic cancers were identified among 794 pancreatic cancers during the study period. After matching based on body mass index, tumour size, distance from the right edge of the tumour to the left wall of the PV, and neoadjuvant chemotherapy, a cohort of 78 patients was selected for analysis (1:1 match, 39 per group). Invasion of splenic vein, splenic artery and PV were found in 40 (51.3%), 28 (35.9%) and 23 (29.5%) patients, respectively. RAFAPS was associated with a higher rate of negative retroperitoneal margins (100% vs 84.6%; relative risk\u2009=\u20091.18, 95% confidence interval [CI]: 1.034-1.351; P\u2009=\u20090.025) and less estimated blood loss (150 vs 300\u00a0ml; estimated difference: -\u00a0100\u00a0ml, 95% CI: -\u00a0200-0; P\u2009=\u20090.039) when compared to that of RAMPS.\nRAFAPS is a safe and effective alternative to RAMPS for managing 'shoulder' pancreatic cancers in a minimally invasive era, with decreased blood loss and favourable retroperitoneal margin.",
    "authors": [
        {
            "affiliation": "Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China.",
            "firstname": "Feng",
            "initials": "F",
            "lastname": "Tian"
        },
        {
            "affiliation": "Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China.",
            "firstname": "Jianlu",
            "initials": "J",
            "lastname": "Zhang"
        },
        {
            "affiliation": "Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China.",
            "firstname": "Kehan",
            "initials": "K",
            "lastname": "Jin"
        },
        {
            "affiliation": "Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China.",
            "firstname": "Yu",
            "initials": "Y",
            "lastname": "Wang"
        },
        {
            "affiliation": "Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China.",
            "firstname": "Taiping",
            "initials": "T",
            "lastname": "Zhang"
        },
        {
            "affiliation": "Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China. gjcpumch@163.com.",
            "firstname": "Junchao",
            "initials": "J",
            "lastname": "Guo"
        }
    ],
    "conclusions": "RAFAPS is a safe and effective alternative to RAMPS for managing 'shoulder' pancreatic cancers in a minimally invasive era, with decreased blood loss and favourable retroperitoneal margin.",
    "copyrights": "\u00a9 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.",
    "doi": "10.1007/s00464-025-11560-4\n10.3322/caac.21820\n10.21037/jgo.2018.12.08\n10.1007/s00464-020-07908-7\n10.1067/msy.2003.146\n10.1002/ijc.29242\n10.3390/cancers2042001\n10.1016/j.surg.2016.11.014\n10.1016/j.jamcollsurg.2014.12.017\n10.1097/01.sla.0000133083.54934.ae\n10.1002/bjs.11292\n10.1002/bjs.10434\n10.1007/s00464-019-07047-8\n10.1016/j.surg.2015.07.001\n10.1002/bjs.10870",
    "journal": "Surgical endoscopy",
    "keywords": [
        "Propensity score-matching",
        "Radical antegrade modular pancreatosplenectomy",
        "Retrograde artery first approach pancreatosplenectomy",
        "Shoulder pancreatic cancer"
    ],
    "methods": null,
    "publication_date": "2025-02-05",
    "pubmed_id": "39904792\n38230766\n31032093\n32875408\n12773980\n25273947\n24281214\n28040257\n25667139\n15273542\n31454072\n28004852\n31463719\n26253244\n29708592",
    "results": "In total, 135 (17.0%) 'shoulder' pancreatic cancers were identified among 794 pancreatic cancers during the study period. After matching based on body mass index, tumour size, distance from the right edge of the tumour to the left wall of the PV, and neoadjuvant chemotherapy, a cohort of 78 patients was selected for analysis (1:1 match, 39 per group). Invasion of splenic vein, splenic artery and PV were found in 40 (51.3%), 28 (35.9%) and 23 (29.5%) patients, respectively. RAFAPS was associated with a higher rate of negative retroperitoneal margins (100% vs 84.6%; relative risk\u2009=\u20091.18, 95% confidence interval [CI]: 1.034-1.351; P\u2009=\u20090.025) and less estimated blood loss (150 vs 300\u00a0ml; estimated difference: -\u00a0100\u00a0ml, 95% CI: -\u00a0200-0; P\u2009=\u20090.039) when compared to that of RAMPS.",
    "title": "Propensity score-matching analysis of retrograde artery first approach pancreatosplenectomy versus radical antegrade modular pancreatosplenectomy for 'shoulder' pancreatic cancers.",
    "xml": "<Element 'PubmedArticle' at 0x788504aca840>"
}