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21 June 2019 : Meta-Analysis  

Comparison of Radical Antegrade Modular Pancreatosplenectomy with Standard Retrograde Pancreatosplenectomy for Left-Sided Pancreatic Cancer: A Meta-Analysis and Experience of a Single Center

Zhen Huo1ABE, Shuyu Zhai1ABE, Yue Wang1BC, Hao Qian1BC, Xiaomei Tang1B, Yusheng Shi1C, Yuanchi Weng1E, Shulin Zhao1AD*, Xiaxing Deng1AD, Baiyong Shen1AD

DOI: 10.12659/MSM.914540

Med Sci Monit 2019; 25:4590-4601

Abstract

BACKGROUND: Radical antegrade modular pancreatosplenectomy (RAMPS) has been reported as a modified surgical technique used to achieve better margin resection and to retrieve more lymph nodes compared with standard retrograde pancreatosplenectomy (SRPS).

MATERIAL AND METHODS: A systematic literature review was performed to identify studies published in PubMed, EmBase, and Web of Science. Hazard ratio (HR), risk ratio (RR), weighted mean difference (WMD), and their 95% confidence intervals (95% CIs) were used as effect measures. In addition, the clinical data of 27 patients in our center were collected and retrospectively analyzed.

RESULTS: Seven studies containing 474 patients were finally enrolled in this meta-analysis. The pooled results showed that the RAMPS group had a better overall survival (OS) compared with the SRPS group (HR=0.65, 95% CI: 0.43–0.99, P=0.046; I²=41.8%, P=0.143). Significantly more lymph nodes were harvested in the RAMPS group compared with in the SRPS group (WMD=4.74, 95% CI: 0.36–9.12, P=0.034). Recurrence rate (RR=0.8, 95% CI: 0.66–0.98, P=0.028) and blood loss (WMD=–153.19 ml, 95% CI: –303.95 to –2.42, P=0.046) were both significantly reduced in the RAMPS group. Retrospective analysis results showed that only significantly more harvested lymph nodes were noted in the RAMPS group compared with the SRPS group (7.55±0.91 vs. 2.81±0.73, P=0.001).

CONCLUSIONS: Our study suggests that RAMPS has better prognosis and surgical outcomes than SRPS for left-sided pancreatic cancer. Nevertheless, more high-quality clinical trials are required to validate the result.

Keywords: general surgery, meta-analysis, Pancreatic Neoplasms, Prognosis, Adenocarcinoma, Aged, Aged, 80 and over, Lymph Node Excision, Lymph Nodes, Margins of Excision, Middle Aged, Neoplasm Recurrence, Local, Odds Ratio, Pancreatectomy, Prospective Studies, Retrospective Studies, Risk Factors, Splenectomy, Treatment Outcome

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Medical Science Monitor Basic Research eISSN: 2325-4416
Medical Science Monitor Basic Research eISSN: 2325-4416