Comparison of laparoscopic versus open radical antegrade modular pancreatosplenectomy for pancreatic cancer: A systematic review and meta-analysis

作者全名："Tang, Wei; Zhang, Yu-Fei; Zhao, Yu-Fei; Wei, Xu-Fu; Xiao, Heng; Wu, Qiao; Du, Cheng-You; Qiu, Jian-Guo"

作者地址："[Tang, Wei; Wei, Xu-Fu; Xiao, Heng; Wu, Qiao; Du, Cheng-You; Qiu, Jian-Guo] Chongqing Med Univ, Affiliated Hosp 1, Dept Hepatobiliary Surg, Chongqing, Peoples R China; [Tang, Wei] Cent South Univ, Xiangya Hosp, Dept Urol, Changsha, Peoples R China; [Zhang, Yu-Fei] Chongqing Med Univ, Yongchuan Hosp, Dept Oncol, Chongqing, Peoples R China; [Zhao, Yu-Fei] Ninth Peoples Hosp Chongqing, Dept Gen Surg, Chongqing, Peoples R China; [Qiu, Jian-Guo] 1 Youyi Rd, Chongqing 400000, Peoples R China"

通信作者："Qiu, JG (通讯作者)，1 Youyi Rd, Chongqing 400000, Peoples R China."

来源：INTERNATIONAL JOURNAL OF SURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000817637600005

JCR分区：Q1

影响因子：15.3

年份：2022

卷号：103

期号：　

开始页：　

结束页：　

文献类型：Review

关键词：Pancreatic cancer; Laparoscopic radical antegrade modular; pancreatosplenectomy; RAMPS; Oncological outcomes; Minimal invasive surgery

摘要："Background: Laparoscopic radical antegrade modular pancreatosplenectomy (l-RAMPS) provides a new surgical approach for patients with pancreatic cancers of the body and tail. However, whether it can achieve comparable outcomes to the open RAMPS (o-RAMPS) remains an issue.Methods: To evaluate the safety and effectiveness of l-RAMPS, the studies in the databases of Medline, Embase, and the Cochrane Library published before September 13, 2021 were searched and a meta-analysis was performed using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. The perioperative and oncological outcomes were analyzed.Results: Five retrospective cohorts involving 189 patients were included for final pooled analysis. There were no significant differences in the patients' operation time, intra-abdominal bleeding rate, intra-abdominal infection rate, mild morbidity (Clavien-Dindo classification = 1), moderate to severe morbidity (Clavien-Dindo classification >= 2), overall morbidity, wound infection rate, pancreatic fistula rate, delayed gastric emptying rate, reoperation rate, length of hospital stay, postoperative mortality, R0 resection rate, and 2-year overall survival between the 2 approaches. Besides, l-RAMPS was associated with less blood loss (mean difference (MD) = -232.69, 95% confidence interval (CI) = -316.93 to -148.46, P < 0.00001) and shorter days until oral feeding (MD = -0.79, 95% CI = -1.35 to -0.22, P = 0.006). However, the pooled analysis also indicated a significantly fewer lymph nodes dissected (MD = -3.01, 95% CI = -5.59 to -0.43, P = 0.02) in l-RAMPS approach. Conclusions: Although l-RAMPS provides similar outcomes associated with benefits of minimal invasiveness compared to o-RAMPS, it harvested significantly fewer lymph nodes which might have potentially negative influence on the patients' long-term survival. L-RAMPS is still in the infancy stage and further investigation is needed to verify its feasibility."

基金机构："National Natural Science Founda-tion of China, China [81702408]; Basic Research and Frontier Exploration Project of Chongqing Science and Technology Commission, China [cstc2017jcyjBX0010, cstc2018jscx-msybX0133]"

基金资助正文："Sources of funding This study was supported by the National Natural Science Founda-tion of China, China (81702408) and the Basic Research and Frontier Exploration Project of Chongqing Science and Technology Commission, China (cstc2017jcyjBX0010, cstc2018jscx-msybX0133) ."