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

Abstract

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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