A systematic scoping review of the initial experience with laparoscopic radical antegrade modular pancreatosplenectomy for pancreatic malignancy

Larkins, Kirsten; Rowcroft, Alistair; Pandanaboyana, Sanjay; Loveday, Benjamin

doi:10.1007/s00464-021-08528-5

Cited by 12 publications

(9 citation statements)

References 24 publications

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“…However, high-level evidence to support a survival benefit following RAMPS is still lacking. With respect to MI-RAMPS, a recent systematic review, including eight studies with 92 cases, demonstrated technical feasibility and oncologically acceptable outcomes for the treatment of pancreatic cancer (6). To date, however, there are no published meta-analyses that compare surgical and oncological outcomes of MI-and open-RAMPS.…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review of Minimally Invasive Versus Open Radical Antegrade Modular Pancreatosplenectomy for Pancreatic Cancer

et al. 2022

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Background/Aim: The aim of this study was to investigate surgical and oncological outcomes of minimally invasive (MI) and open radical antegrade modular pancreatosplenectomy (RAMPS) for the treatment of left-sided pancreatic cancer. Materials and Methods: A systematic literature search and meta-analyses were performed focusing on short-term surgical oncology of MI-and open-RAMPS. Results: A total of seven studies with 423 patients were included in this review. The equivalent short-term and long-term outcomes of the groups were confirmed. The results of meta-analyses found no significant difference in R0 resection rates (OR=1.78, p=0.18), although MI-RAMPS was associated with a smaller number of dissected lymph nodes p<0.001) and lymph node metastases (OR=0. 55, p=0.04). Conclusion: MI-RAMPS could provide surgically and oncologically feasible outcomes for wellselected left-sided pancreatic cancer as compared to open-RAMPS. However, further high-level evidence should be needed to confirm survival benefits following MI-RAMPS. Radical antegrade modular pancreatosplenectomy (RAMPS) is a standardized technique for left-sided pancreatic cancer (1).The feasibility of applying RAMPS to patients with pancreatic cancer has been demonstrated (2-4). In contrast, the evidence of minimally invasive distal pancreatectomy for pancreatic cancer is still lacking despite recent rapid development of minimally invasive pancreas resection (5). This is because that there are several critical issues still under debate with respect to surgical and oncological feasibility of minimally invasive RAMPS (MI-RAMPS) over open RAMPS (open-RAMPS) (6).To date, surgical and oncological feasibility of MI-RAMPS compared to open-RAMPS have not yet been systemically examined in patients with pancreatic cancer.The aim of this study was to investigate surgical and oncological outcomes of MI-RAMPS in comparison with those of open-RAMPS. Furthermore, meta-analysis was performed focusing on short-term surgical oncology of MIand open-RAMPS for pancreatic cancer. Materials and MethodsSearch methodology. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (7). A systematic search of Pubmed Central, Web of Science, and Cochrane CENTRAL was performed on August 7 th , 2021, radical antegrade modular pancreatosplenectomy as a key word phrase.Reports in the English language that compared outcomes of MIand open-RAMPS for pancreatic cancer were included. Reports without abstracts, conference abstracts, and reviews were excluded.Following the removal of duplicate records, all abstracts were screened independently by two investigators. Next, full-text manuscripts were assessed for eligibility. Extracted data were as follows: year and country of study publication, study design, surgical approach (MI-or open-RAMPS), operative outcomes (operative time and blood loss), pathological outcomes (tumor size, number of dissected lymph nodes and lymph node metastasis, and R0 resection rates), sh...

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Section: Discussionmentioning

confidence: 99%

“…Therefore, further studies should be conducted to investigate survival benefits following MI-and open-RAMPS for pancreatic cancer. Thirdly, various surgical techniques for MI-RAMPS were reported (6). Moreover, evidence on robotic RAMPS for pancreatic cancer is still lacking.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Minimally Invasive Versus Open Radical Antegrade Modular Pancreatosplenectomy for Pancreatic Cancer

et al. 2022

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“…No statistical differences were found in short-term oncological outcomes between L-RAMPS and O-RAMPS. [28,29]…”

Section: Introductionmentioning

confidence: 99%

“…[27] Studies found no statistical differences in hospital stay, intraoperative blood loss, and pancreatic fistula between laparoscopic RAMPS (L-RAMPS) and open RAMPS (O-RAMPS). [28,29]…”

Section: Introductionmentioning

confidence: 99%

Chinese expert consensus on minimally invasive radical surgery for pancreatic ductal adenocarcinoma (version 2022)

Zhao

Wang

et al. 2022

Journal of Pancreatology

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Various types of minimally invasive pancreatic surgery have been carried out in the last decades with promising outcomes reported by early explorers. Nevertheless, there are still controversies on oncologic outcomes and safety in the use of minimally invasive radical surgery for pancreatic ductal adenocarcinoma (PDAC). This consensus, referring to Chinese expert opinions and worldwide researches, aimed to discuss the related issues on minimally invasive radical surgery for PDAC to ensure the perioperative and oncological outcomes. Quality of evidence and strength of recommendations were evaluated based on the GRADE approach. The 15 recommendations covered 5 topics: oncological outcomes and patient safety of laparoscopic and robotic pancreatoduodenectomy, left-side pancreatectomy for PDAC, learning curve, safety of neoadjuvant therapy, and vascular resection in minimally invasive radical surgery for PDAC. This consensus gives reference and guidance to surgeons on the use of minimally invasive radical surgery for PDAC. Although this consensus is not sufficient to answer all the questions about minimally invasive radical surgery for PDAC, it represents the current consensus on the application of the techniques in the treatment of PDAC on the Chinese mainland.

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“…Furthermore, laparoscopic distal pancreatectomy (LDPS) has purported benefits for short-term and long-term outcomes compared to open DPS ( 5 , 6 ). Similarly, laparoscopic RAMPS (LRAMPS) has been demonstrated to be more feasible ( 7 – 9 ). In a recent meta-analysis to date comparing minimally invasive RAMPS (MI-RAMPS) against open RAMPS, intra-operative blood loss was observed to be significantly reduced in MI-RAMPS, while lymph node yield was higher in O-RAMPS and there was no difference in overall survival (OS) ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome comparison of laparoscopic radical antegrade modular pancreatosplenectomy vs. laparoscopic distal pancreatosplenectomy for left-sided pancreatic ductal adenocarcinoma surgical resection

Niu

Mou

et al. 2022

Front. Surg.

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BackgroundLaparoscopic radical antegrade modular pancreatosplenectomy (LRAMPS) is a validated surgical treatment for patients with left-sided pancreatic ductal adenocarcinoma (PDAC). In addition, laparoscopic distal pancreatectomy (LDPS) has purported benefits. However, there is a limited analysis comparing the results between LRAMPS and LDPS. Thus, this study aims to compare the short-term and long-term outcomes of patients who underwent LRAMPS and LDPS for PDAC treatment.MethodsPatients with left-sided PDAC that underwent LRAMPS or LDPS from 2015 to 2021 were retrospectively identified. Demographic and clinic pathologic data were collected. Disease-free survival (DFS) and overall survival (OS) probabilities were obtained.ResultsThe number of lymph nodes retrieved was significantly greater in the LRAMPS group than in the LDPS group. Several clinicopathological factors, including CA19-9 levels greater than 37 U/ml, positive lymph nodes, moderate to poor tumor differentiation, and peripancreas fat invasion, were associated with DFS. Moderate with poor tumor differentiation was associated with poor DFS (HR 0.568; 95% CI 0.373–0.921; P = 0.021). Levels of CA19-9 greater than 37 U/ml, CEA levels greater than 5 μg/ml, larger tumor size, positive lymph nodes, moderate with poor tumor differentiation, peripancreas fat invasion, and adjuvant chemotherapy were all associated with OS. LRAMPS nearly improved OS but did not reach statistical significance. Serum carcinoembryonic antigen (CEA) levels greater than 5 ug/ml (HR 1.693; 95% CI 1.200–1.132; P = 0.001), and positive lymph nodes (HR 2.410; 95% CI 1.453–3.995; P = 0.001) were independently associated with poor OS. Treatment with adjuvant chemotherapy was associated with improved OS (HR 0.491; 95% CI 0.248–0.708; P = 0.001).ConclusionsThe LRAMPS procedure achieved comparable results to standard LDPS in terms of postoperative outcomes. Treatment with chemotherapy is important for the prognosis of patients with left-sided pancreatic cancer.

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A systematic scoping review of the initial experience with laparoscopic radical antegrade modular pancreatosplenectomy for pancreatic malignancy

Cited by 12 publications

References 24 publications

A Systematic Review of Minimally Invasive Versus Open Radical Antegrade Modular Pancreatosplenectomy for Pancreatic Cancer

A Systematic Review of Minimally Invasive Versus Open Radical Antegrade Modular Pancreatosplenectomy for Pancreatic Cancer

Chinese expert consensus on minimally invasive radical surgery for pancreatic ductal adenocarcinoma (version 2022)

Clinical outcome comparison of laparoscopic radical antegrade modular pancreatosplenectomy vs. laparoscopic distal pancreatosplenectomy for left-sided pancreatic ductal adenocarcinoma surgical resection

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