Zhou Yating, Xue Fei
Kunshan Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu, China.
Front Oncol. 2025 Jan 23;14:1513520. doi: 10.3389/fonc.2024.1513520. eCollection 2024.
Pancreatic ductal adenocarcinoma (PDAC) is a major public health concern, ranking as the fourth leading cause of cancer-related mortality in the United States. Traditional surgical approaches often yield suboptimal outcomes, highlighting the need for innovative surgical strategies. Radical antegrade modular pancreatosplenectomy (RAMPS) has demonstrated improvements in surgical visualization and oncological outcomes. Recently, laparoscopic RAMPS (L-RAMPS) has been introduced as a minimally invasive alternative.
This meta-analysis aims to compare the safety and efficacy of open RAMPS (O-RAMPS) versus L-RAMPS, focusing on operative outcomes, minimally invasive outcomes, intra-abdominal outcomes, overall postoperative outcomes, and oncologic outcomes.
A systematic review and meta-analysis were conducted following PRISMA guidelines. Eligible studies included prospective or retrospective cohort studies and randomized controlled trials comparing L-RAMPS with O-RAMPS. Data were extracted from EMBASE, PubMed, and the Cochrane Library databases through September 16, 2023. The ROBINS-I tool was used to assess the risk of bias. Statistical analyses included odds ratios (OR), risk differences (RD), mean differences (MD), and survival analyses.
Eight studies involving 588 patients were included. O-RAMPS was associated with longer operative times (MD = 39.39 minutes, 95% CI = 22.93 to 55.84) and greater blood loss (MD = -231.84 mL, 95% CI = -312.00 to -151.69). No significant differences were observed in blood transfusion rates, pancreatic fistula rates, delayed gastric emptying, or length of hospital stay. L-RAMPS demonstrated a shorter time to oral feeding (MD = -0.79 days, 95% CI = -1.35 to -0.22). Survival analysis suggested a potentially improved long-term prognosis for L-RAMPS.
L-RAMPS offers advantages over O-RAMPS in terms of reduced blood loss, faster time to oral feeding, and potentially better long-term prognosis. Further research is warranted, particularly regarding the learning curve of L-RAMPS and its broader applicability.
https://www.crd.york.ac.uk/prospero, identifier CRD42024498383.
胰腺导管腺癌（PDAC）是一个重大的公共卫生问题，在美国是癌症相关死亡的第四大主要原因。传统的手术方法往往产生不理想的结果，这凸显了创新手术策略的必要性。根治性顺行模块化胰脾切除术（RAMPS）已显示出手术视野和肿瘤学结果的改善。最近，腹腔镜RAMPS（L-RAMPS）作为一种微创替代方法被引入。
本荟萃分析旨在比较开放RAMPS（O-RAMPS）与L-RAMPS的安全性和有效性，重点关注手术结果、微创结果、腹腔内结果、总体术后结果和肿瘤学结果。
按照PRISMA指南进行系统评价和荟萃分析。符合条件的研究包括前瞻性或回顾性队列研究以及比较L-RAMPS与O-RAMPS的随机对照试验。数据通过2023年9月16日从EMBASE、PubMed和Cochrane图书馆数据库中提取。使用ROBINS-I工具评估偏倚风险。统计分析包括比值比（OR）、风险差异（RD）、均值差异（MD）和生存分析。
纳入了八项涉及588例患者的研究。O-RAMPS与更长的手术时间（MD = 39.39分钟，95%CI = 22.93至55.84）和更多的失血量（MD = -231.84 mL，95%CI = -312.00至-151.69）相关。在输血率、胰瘘率、胃排空延迟或住院时间方面未观察到显著差异。L-RAMPS显示开始经口进食的时间更短（MD = -0.79天，95%CI = -1.35至-0.22）。生存分析表明L-RAMPS可能有更好的长期预后。
L-RAMPS在减少失血量、更快开始经口进食以及可能更好的长期预后方面优于O-RAMPS。有必要进行进一步研究，特别是关于L-RAMPS的学习曲线及其更广泛的适用性。
