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\u2009<\u20090.05) in the operation time [WMD\u2009=\u2009−\u200963.93, 95% CI (−\u200968.86 ~\u2009−\u200958.99), P<0.00001], and bleeding volume [WMD\u2009=\u2009−\u2009184.62, 95% CI (−\u2009211.88 ~\u2009−\u2009157.37), 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\u2009=\u20092.37, 95% CI (1.19 ~\u20094.72), P\u2009=\u20090.01] and the number of lymph node excision [WMD\u2009=\u20097.08, 95% CI (4.59 ~\u20099.58), P<0.000013]. The one-year overall survival rate was higher in RAMPS patients compared to DP patients [RR\u2009=\u20091.20, 95% CI (1.02 ~\u20091.41), P\u2009=\u20090.02]. But there were no significant difference in postoperative recurrence [RR\u2009=\u20090.85, 95% CI (0.70 ~\u20091.04), P\u2009=\u20090.13] 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.