Cao Feng, Li Jia, Li Ang, Li Fei
Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People's Republic of China.
BMC Surg. 2017 Jun 5;17(1):67. doi: 10.1186/s12893-017-0259-1.
Radical antegrade modular pancreatosplenectomy (RAMPS), first reported by Strasberg in 2003, has attracted increasing attention in the treatment of left-sided pancreatic cancer. The limited number of cases eligible for RAMPS makes it difficult to perform any prospective randomized trial of RAMPS versus the standard procedure. Therefore, we performed this systemic review and meta-analysis of the current data to clarify the role of the RAMPS procedure.
A literature search was performed in electronic databases, including PubMed, Medline, Embase, CNKI and the Cochrane Library. Studies comparing RAMPS with the standard procedure were included in this meta-analysis. R0 resection rate, recurrence rate at the end of the follow-up, overall survival (OS) and disease-free survival (DFS) were measured as primary outcomes. Revman 5.3 was used to perform the analysis.
Six retrospective cohort studies with a total number of 378 patients were included in our analysis. Meta-analysis revealed that RAMPS was correlated with higher R0 resection rates [Odds Ratio (OR) 95% confidence interval (CI), 2.19 (1.16 ~ 4.13); P = 0.02] and successful harvest of more lymph nodes [weighted mean difference (WMD) 95% CI, 7.06 (4.52 ~ 9.60); P < 0.01] compared with the standard procedure. However, no statistically significant difference was found between the procedures with respect to recurrence rates [OR 95% CI, 0.66 (0.40 ~ 1.09); P = 0.10], OS [Hazard ratio (HR) 95% CI, 0.65 (0.42 ~ 1.00); P = 0.05] or DFS [HR 95% CI, 1.02 (0.62 ~ 1.68); P = 0.93].
RAMPS is safe and oncologically superior to the standard procedure for the treatment of left-sided pancreatic cancer. However, high-grade evidence will be necessary to confirm the potential survival benefits of RAMPS.
根治性顺行模块化胰脾切除术（RAMPS）由斯特拉斯伯格于2003年首次报道，在左侧胰腺癌的治疗中受到越来越多的关注。符合RAMPS手术的病例数量有限，因此难以开展任何关于RAMPS与标准手术的前瞻性随机试验。因此，我们对当前数据进行了这项系统评价和荟萃分析，以阐明RAMPS手术的作用。
在包括PubMed、Medline、Embase、中国知网和考克兰图书馆在内的电子数据库中进行文献检索。本荟萃分析纳入了比较RAMPS与标准手术的研究。将R0切除率、随访结束时的复发率、总生存期（OS）和无病生存期（DFS）作为主要结局指标。使用Revman 5.3进行分析。
我们的分析纳入了6项回顾性队列研究，共378例患者。荟萃分析显示，与标准手术相比，RAMPS的R0切除率更高[比值比（OR）95%置信区间（CI），2.19（1.164.13）；P=0.02]，且能成功获取更多淋巴结[加权均数差（WMD）95%CI，7.06（4.529.60）；P<0.01]。然而，在复发率[OR 95%CI，0.66（0.401.09）；P=0.10]、OS[风险比（HR）95%CI，0.65（0.421.00）；P=0.05]或DFS[HR 95%CI，1.02（0.62~1.68）；P=0.93]方面，两种手术之间未发现统计学上的显著差异。
对于左侧胰腺癌的治疗，RAMPS是安全的，并且在肿瘤学方面优于标准手术。然而，需要高级别证据来证实RAMPS潜在的生存获益。
