Assessement of postoperative long-term survival quality and complications associated with radical antegrade modular pancreatosplenectomy and distal pancreatectomy: a meta-analysis and systematic review

Abstract

BackgroundThis study evaluated the perioperative complications and the long-term pancreatic survival outcomes in patients treated with radical antegrade modular pancreatosplenectomy (RAMPS) and distal pancreatectomy (DP).MethodWe performed a computer search on the PubMed, Embase and Cochrane Library databases to retrieve the RCT or clinical trials comparing RAMPS and DP published before July of 2018. The quality of the included trials was assessed according to the inclusion and exclusion criteria by two researchers independently. The RevMan 5.3 software was used to extract and analyze the data.ResultA total of 5 retroprospective clinical trial articles comprising 285 patients were included in the study. The number of patients who underwent RAMPS were 135 and 150 for DP. There were significant differences (P < 0.05) in the operation time [WMD = − 63.93, 95% CI (− 68.86 ~ − 58.99), P<0.00001], and bleeding volume [WMD = − 184.62, 95% CI (− 211.88 ~ − 157.37), P<0.00001] between the two groups. However, no significant differences were observed between RAMPS and DP in terms of pancreatic fistula, postoperative complications, postoperative hospital stay, and mortality (P>0. 05). As for pathological examination, there were statistically significant differences between RAMPS and DP in the R0 resection rate [RR = 2.37, 95% CI (1.19 ~ 4.72), P = 0.01] and the number of lymph node excision [WMD = 7.08, 95% CI (4.59 ~ 9.58), P<0.000013]. The one-year overall survival rate was higher in RAMPS patients compared to DP patients [RR = 1.20, 95% CI (1.02 ~ 1.41), P = 0.02]. But there were no significant difference in postoperative recurrence [RR = 0.85, 95% CI (0.70 ~ 1.04), P = 0.13] between the two groups. Conclusion: RAMPS is an effective procedure for clinical application. Nevertheless, large, multicenter prospective randomized controlled trias are required to validate these findings.ConclusionThe RAMPS procedure was associated with good postoperative outcomes and overall survival, indicating that it is an effective procedure for clinical application. Large, multicenter prospective randomized controlled trials are needed to validate these findings.Electronic supplementary materialThe online version of this article (10.1186/s12893-019-0476-x) contains supplementary material, which is available to authorized users.

Treatment of Advanced Pancreatic Body and Tail Cancer by En Bloc Distal Pancreatectomy with Transverse Mesocolon Resection Using a Mesenteric Approach

“…The procedure was named "RAMPS," and at present, it is performed extensively worldwide as the primary procedure for advanced cancer of the pancreatic body and tail. [23][24][25][26] RAMPS and our proposed DP-TCR procedure aim to achieve histologically radical surgery. Both procedures have the same philosophy in that they attempt to resect the retroperitoneum en bloc with the pancreatic body and tail and the spleen.…”

Robotic radical antegrade modular pancreatosplenectomy(RAMPS) versus standard retrograde pancreatosplenectomy (SRPS):study protocol for a randomized controlled trial

“…It was reported a few years ago that, compared with SRPS, RAMPS showed significant improvement in R0 resection rate and 5-year survival rate [5,6] . However, reports in recent years have shown that despite the theoretic advantages of RAMPS over SRPS, high-level evidence that demonstrates a survival benefit with RAMPS does not currently exist [7,8]. RAMPS 'potential survival advantage still needs to be proven.…”

Open and Minimal Approaches to Pancreatic Adenocarcinoma

“…Indeed, a recent meta-analysis demonstrated that minimally invasive DPS had comparable 5-year survival to open surgery with significantly lower positive margin rates, shorter in-patient hospital stay, less blood loss, and lower patient morbidity and mortality [64]. As discussed above, the data on RAMPS is limited by analysis of retrospective data which demonstrate that there is no increase in POPF, complications, and mortality but a significantly improved R0 rate and number of lymph nodes resected [65]. Although as Cao et al state further, trial data are needed before confirmation of the survival benefits of RAMPS which can be assessed although the authors state that based upon their meta-analysis, RAMPS is an oncologically superior procedure [66].…”