Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Italy; Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy.
Division of General and Transplant Surgery, University of Pisa, Italy.
HPB (Oxford). 2024 Jan;26(1):44-53. doi: 10.1016/j.hpb.2023.09.013. Epub 2023 Sep 14.
The safety and efficacy of minimally invasive radical antegrade modular pancreatosplenectomy (MI-RAMPS) remain to be established in pancreatic cancer (PDAC) METHODS: Eighty-five open (O)-RAMPS were compared to 93 MI-RAMPS. The entropy balance matching approach was used to compare the two cohorts, eliminating the selection bias. Three models were created. Model 1 made O-RAMPS equal to the MI-RAMPS cohort (i.e., compared the two procedures for resectable PDAC); model 2 made MI-RAMPS equal to O-RAMPS (i.e., compared the two procedures for borderline-resectable PDAC); model 3, compared robotic and laparoscopic RAMPS.
O-RAMPS and MI-RAMPS showed "non-small" differences for BMI, comorbidity, back pain, tumor size, vascular resection, anterior or posterior RAMPS, multi-visceral resection, stump management, grading, and neoadjuvant therapy. Before reweighting, O-RAMPS had fewer clinically relevant postoperative pancreatic fistulae (CR-POPF) (20.0% vs. 40.9%; p = 0.003), while MI-RAMPS had a higher mean of lymph nodes (25.7 vs. 31.7; p = 0.011). In model 1, MI-RAMPS and O-RAMPS achieved similar results. In model 2, O-RAMPS was associated with lower comprehensive complication index scores (MD = 11.2; p = 0.038), and CR-POPF rates (OR = 0.2; p = 0.001). In model 3, robotic-RAMPS had a higher probability of negative resection margins.
In patients with anatomically resectable PDAC, MI-RAMPS is feasible and as safe as O-RAMPS.
微创经前路模块式胰脾切除术（MI-RAMPS）在胰腺癌（PDAC）中的安全性和有效性尚待确定。
将 85 例开放式（O）-RAMPS 与 93 例 MI-RAMPS 进行比较。采用熵平衡匹配方法对两组进行比较，消除选择偏倚。建立了 3 种模型。模型 1 使 O-RAMPS 与 MI-RAMPS 队列相等（即比较两种可切除 PDAC 的手术方法）；模型 2 使 MI-RAMPS 与 O-RAMPS 相等（即比较两种边界可切除 PDAC 的手术方法）；模型 3 比较了机器人和腹腔镜 RAMPS。
O-RAMPS 和 MI-RAMPS 在 BMI、合并症、背痛、肿瘤大小、血管切除、前或后 RAMPS、多脏器切除、残端处理、分级和新辅助治疗方面存在“非小”差异。在重新加权之前，O-RAMPS 术后发生临床相关胰瘘（CR-POPF）的比例较低（20.0% vs. 40.9%；p=0.003），而 MI-RAMPS 的淋巴结平均值较高（25.7 对 31.7；p=0.011）。在模型 1 中，MI-RAMPS 和 O-RAMPS 取得了相似的结果。在模型 2 中，O-RAMPS 与较低的综合并发症指数评分（MD=11.2；p=0.038）和 CR-POPF 发生率（OR=0.2；p=0.001）相关。在模型 3 中，机器人-RAMPS 有更高的阴性切缘概率。
在解剖上可切除的 PDAC 患者中，MI-RAMPS 是可行的，与 O-RAMPS 一样安全。
