The efficacy of radical antegrade modular pancreatosplenectomy: A systematic review and meta‐analysis
Background/Purpose Previous systematic reviews have shown that radical antegrade modular pancreatosplenectomy (RAMPS) had favorable outcomes including prognosis. However, recent large studies have shown opposite results, thus necessitating clarification of RAMPS efficacy. We aimed to update existing...
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| Published in: | Journal of hepato-biliary-pancreatic sciences Vol. 29; no. 11; pp. 1156 - 1165 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Japan
Wiley Subscription Services, Inc
01.11.2022
John Wiley and Sons Inc |
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| ISSN: | 1868-6974, 1868-6982, 1868-6982 |
| Online Access: | Get full text |
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| Abstract | Background/Purpose
Previous systematic reviews have shown that radical antegrade modular pancreatosplenectomy (RAMPS) had favorable outcomes including prognosis. However, recent large studies have shown opposite results, thus necessitating clarification of RAMPS efficacy. We aimed to update existing evidence on the clinical outcomes of RAMPS for left‐sided pancreatic cancer by comparing them to those of the conventional approach.
Methods
Electronic databases and registries were searched until August 2021 to perform random‐effect meta‐analysis. Methodological quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The protocol was registered at protocols.io (https://doi.org/10.17504/protocols.io.bxhfpj3n).
Results
Thirteen cohort studies (1641 patients) and four ongoing randomized controlled trials (RCTs) were identified. RAMPS increased disease‐free survival (hazard ratio [HR] 0.62, 95% confidence interval [CI] = 0.42‐0.91), but it had little effect on overall survival (HR 0.92, 95% CI = 0.79‐1.09) and recurrence‐free survival (HR 0.72, 95% CI = 0.37‐1.38) with low certainty of evidence.
Conclusion
The meta‐analysis of recent studies suggests that RAMPS may have little effect on clinical outcomes. These findings highlight the necessity of further studies, including RCTs to determine the efficacy and subsequent indication of RAMPS in clinical cases. |
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| AbstractList | Background/Purpose
Previous systematic reviews have shown that radical antegrade modular pancreatosplenectomy (RAMPS) had favorable outcomes including prognosis. However, recent large studies have shown opposite results, thus necessitating clarification of RAMPS efficacy. We aimed to update existing evidence on the clinical outcomes of RAMPS for left‐sided pancreatic cancer by comparing them to those of the conventional approach.
Methods
Electronic databases and registries were searched until August 2021 to perform random‐effect meta‐analysis. Methodological quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The protocol was registered at protocols.io (https://doi.org/10.17504/protocols.io.bxhfpj3n).
Results
Thirteen cohort studies (1641 patients) and four ongoing randomized controlled trials (RCTs) were identified. RAMPS increased disease‐free survival (hazard ratio [HR] 0.62, 95% confidence interval [CI] = 0.42‐0.91), but it had little effect on overall survival (HR 0.92, 95% CI = 0.79‐1.09) and recurrence‐free survival (HR 0.72, 95% CI = 0.37‐1.38) with low certainty of evidence.
Conclusion
The meta‐analysis of recent studies suggests that RAMPS may have little effect on clinical outcomes. These findings highlight the necessity of further studies, including RCTs to determine the efficacy and subsequent indication of RAMPS in clinical cases. Previous systematic reviews have shown that radical antegrade modular pancreatosplenectomy (RAMPS) had favorable outcomes including prognosis. However, recent large studies have shown opposite results, thus necessitating clarification of RAMPS efficacy. We aimed to update existing evidence on the clinical outcomes of RAMPS for left-sided pancreatic cancer by comparing them to those of the conventional approach. Electronic databases and registries were searched until August 2021 to perform random-effect meta-analysis. Methodological quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The protocol was registered at protocols.io (https://doi.org/10.17504/protocols.io.bxhfpj3n). Thirteen cohort studies (1641 patients) and four ongoing randomized controlled trials (RCTs) were identified. RAMPS increased disease-free survival (hazard ratio [HR] 0.62, 95% confidence interval [CI] = 0.42-0.91), but it had little effect on overall survival (HR 0.92, 95% CI = 0.79-1.09) and recurrence-free survival (HR 0.72, 95% CI = 0.37-1.38) with low certainty of evidence. The meta-analysis of recent studies suggests that RAMPS may have little effect on clinical outcomes. These findings highlight the necessity of further studies, including RCTs to determine the efficacy and subsequent indication of RAMPS in clinical cases. Previous systematic reviews have shown that radical antegrade modular pancreatosplenectomy (RAMPS) had favorable outcomes including prognosis. However, recent large studies have shown opposite results, thus necessitating clarification of RAMPS efficacy. We aimed to update existing evidence on the clinical outcomes of RAMPS for left-sided pancreatic cancer by comparing them to those of the conventional approach.BACKGROUND/PURPOSEPrevious systematic reviews have shown that radical antegrade modular pancreatosplenectomy (RAMPS) had favorable outcomes including prognosis. However, recent large studies have shown opposite results, thus necessitating clarification of RAMPS efficacy. We aimed to update existing evidence on the clinical outcomes of RAMPS for left-sided pancreatic cancer by comparing them to those of the conventional approach.Electronic databases and registries were searched until August 2021 to perform random-effect meta-analysis. Methodological quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The protocol was registered at protocols.io (https://doi.org/10.17504/protocols.io.bxhfpj3n).METHODSElectronic databases and registries were searched until August 2021 to perform random-effect meta-analysis. Methodological quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The protocol was registered at protocols.io (https://doi.org/10.17504/protocols.io.bxhfpj3n).Thirteen cohort studies (1641 patients) and four ongoing randomized controlled trials (RCTs) were identified. RAMPS increased disease-free survival (hazard ratio [HR] 0.62, 95% confidence interval [CI] = 0.42-0.91), but it had little effect on overall survival (HR 0.92, 95% CI = 0.79-1.09) and recurrence-free survival (HR 0.72, 95% CI = 0.37-1.38) with low certainty of evidence.RESULTSThirteen cohort studies (1641 patients) and four ongoing randomized controlled trials (RCTs) were identified. RAMPS increased disease-free survival (hazard ratio [HR] 0.62, 95% confidence interval [CI] = 0.42-0.91), but it had little effect on overall survival (HR 0.92, 95% CI = 0.79-1.09) and recurrence-free survival (HR 0.72, 95% CI = 0.37-1.38) with low certainty of evidence.The meta-analysis of recent studies suggests that RAMPS may have little effect on clinical outcomes. These findings highlight the necessity of further studies, including RCTs to determine the efficacy and subsequent indication of RAMPS in clinical cases.CONCLUSIONThe meta-analysis of recent studies suggests that RAMPS may have little effect on clinical outcomes. These findings highlight the necessity of further studies, including RCTs to determine the efficacy and subsequent indication of RAMPS in clinical cases. Background/PurposePrevious systematic reviews have shown that radical antegrade modular pancreatosplenectomy (RAMPS) had favorable outcomes including prognosis. However, recent large studies have shown opposite results, thus necessitating clarification of RAMPS efficacy. We aimed to update existing evidence on the clinical outcomes of RAMPS for left‐sided pancreatic cancer by comparing them to those of the conventional approach.MethodsElectronic databases and registries were searched until August 2021 to perform random‐effect meta‐analysis. Methodological quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The protocol was registered at protocols.io (https://doi.org/10.17504/protocols.io.bxhfpj3n).ResultsThirteen cohort studies (1641 patients) and four ongoing randomized controlled trials (RCTs) were identified. RAMPS increased disease‐free survival (hazard ratio [HR] 0.62, 95% confidence interval [CI] = 0.42‐0.91), but it had little effect on overall survival (HR 0.92, 95% CI = 0.79‐1.09) and recurrence‐free survival (HR 0.72, 95% CI = 0.37‐1.38) with low certainty of evidence.ConclusionThe meta‐analysis of recent studies suggests that RAMPS may have little effect on clinical outcomes. These findings highlight the necessity of further studies, including RCTs to determine the efficacy and subsequent indication of RAMPS in clinical cases. |
| Author | Sasanuma, Hideki Sata, Naohiro Rifu, Kazuma Watanabe, Jun Kotani, Kazuhiko |
| AuthorAffiliation | 1 12838 Division of Gastroenterological, General and Transplant Surgery Department of Surgery Jichi Medical University Shimotsuke‐City Japan 2 12838 Division of Community and Family Medicine Jichi Medical University Shimotsuke‐City Japan |
| AuthorAffiliation_xml | – name: 2 12838 Division of Community and Family Medicine Jichi Medical University Shimotsuke‐City Japan – name: 1 12838 Division of Gastroenterological, General and Transplant Surgery Department of Surgery Jichi Medical University Shimotsuke‐City Japan |
| Author_xml | – sequence: 1 givenname: Jun orcidid: 0000-0003-4477-4238 surname: Watanabe fullname: Watanabe, Jun email: m06105jw@jichi.ac.jp organization: Jichi Medical University – sequence: 2 givenname: Kazuma surname: Rifu fullname: Rifu, Kazuma organization: Jichi Medical University – sequence: 3 givenname: Hideki surname: Sasanuma fullname: Sasanuma, Hideki organization: Jichi Medical University – sequence: 4 givenname: Kazuhiko surname: Kotani fullname: Kotani, Kazuhiko organization: Jichi Medical University – sequence: 5 givenname: Naohiro surname: Sata fullname: Sata, Naohiro organization: Jichi Medical University |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35092177$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1007_s10353_023_00812_z crossref_primary_10_1002_wjs_12630 crossref_primary_10_1016_j_suronc_2022_101858 crossref_primary_10_1245_s10434_024_15414_6 crossref_primary_10_1245_s10434_024_15939_w crossref_primary_10_3390_cancers15082322 crossref_primary_10_1007_s00423_024_03417_6 crossref_primary_10_1016_j_hpb_2025_04_001 crossref_primary_10_3389_fonc_2025_1510342 |
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| Keywords | meta-analysis mortality systematic review pancreatic neoplasms prognosis |
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Previous systematic reviews have shown that radical antegrade modular pancreatosplenectomy (RAMPS) had favorable outcomes including... Previous systematic reviews have shown that radical antegrade modular pancreatosplenectomy (RAMPS) had favorable outcomes including prognosis. However, recent... Background/PurposePrevious systematic reviews have shown that radical antegrade modular pancreatosplenectomy (RAMPS) had favorable outcomes including... |
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| SubjectTerms | Clinical outcomes Humans Lymph Node Excision Medical prognosis Meta-analysis mortality Pancreatectomy - methods Pancreatic cancer pancreatic neoplasms Pancreatic Neoplasms - surgery Prognosis Splenectomy - methods Systematic Review |
| Title | The efficacy of radical antegrade modular pancreatosplenectomy: A systematic review and meta‐analysis |
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