Minimally Invasive Surgery Versus Open Surgery in Radical Antegrade Modular Pancreatosplenectomy (RAMPS): A Systematic Review and Meta-Analysis

Abstract

Introduction: RAMPS was first reported in 2003 by Strasberg for the treatment of pancreatic body and tail cancer. Today, minimally invasive distal pancreatectomy can also be performed as a RAMPS procedure. Yet, the safety and efficacy of minimally invasive RAMPS (M-RAMPS) is still controversial. Methods: Clinical trials comparing outcomes of M-RAMPS and O-RAMPS in patients with pancreatic body and tail cancer were sought systematically in MEDLINE, Web of Science and CENTRAL. Main outcomes were pancreatic fistula, delayed gastric emptying (DGE), overall postoperative complications, postoperative haemorrhage. Furthermore, operative time and length of hospital stay were assessed. Pooled results are presented as odds ratios (OR) or mean difference (MD) with 95% confidence interval (CI). Results: 6 observational studies with a total of 296 patients were included in the final analysis. The M-RAMPS group showed a longer operative time. (MD 18.07, 95% CI 3.68 to 32.47) compared to the O-RAMPS group. There were no significant differences regarding rate of pancreatic fistula (OR 1.55, 95% CI 0.85 to 2.83), DGE (OR 1.29, 95% CI 0.46 to 3.63), major postoperative complications (OR 0.96, 95% CI 0.36 to 2.53), postoperative haemorrhage (OR 0.87, 95% CI 0.20 to 3.74) and length of hospital stay (MD -1.58, 95% CI -4.22 to 1.07). Conclusions: This meta-analysis shows that M-RAMPS is a feasible procedure with comparable outcomes compared to O-RAMPS. Due to the longer operation time, it’s actual value cannot finally be assessed. Consequently, more evidence should be generated by high-quality clinical trials in the future.