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
Main Authors: Watanabe, Jun, Rifu, Kazuma, Sasanuma, Hideki, Kotani, Kazuhiko, Sata, Naohiro
Format: Journal Article
Language:English
Published: Japan Wiley Subscription Services, Inc 01.11.2022
John Wiley and Sons Inc
Subjects:
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
meta-analysis
mortality
systematic review
pancreatic neoplasms
prognosis
ISSN:1868-6974, 1868-6982, 1868-6982
Online Access:Get full text
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Summary: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.
Bibliography:Funding information
This work was supported by JSPS KAKENHI Grant Number JP21K21121.
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ISSN:1868-6974
1868-6982
1868-6982
DOI:10.1002/jhbp.1120