背景:腹腔镜根治性顺行模块化胰脾切除术(1-RAMPS)为体尾胰腺癌患者提供了一种新的手术方法。然而,它是否可以实现与开放式RAMPS(o-RAMPS)相当的结果仍然是一个问题。
方法:为了评估l-RAMPS的安全性和有效性,Medline数据库中的研究,Embase,检索2021年9月13日前发表的Cochrane图书馆,并使用2020年系统评价和荟萃分析首选报告项目(PRISMA)指南进行荟萃分析.分析围手术期和肿瘤学结果。
结果:纳入5个回顾性队列,涉及189名患者,进行最终汇总分析。患者手术时间无显著差异,腹腔内出血率,腹腔感染率,轻度发病率(Clavien-Dindo分类=1),中度至重度发病率(Clavien-Dindo分类≥2),总体发病率,伤口感染率,胰瘘率,胃排空率延迟,再手术率,住院时间,术后死亡率,R0切除率,两种方法之间的2年总生存期。此外,1-RAMPS与较少的失血量(平均差异(MD)=-232.69,95%置信区间(CI)=-316.93至-148.46,P<0.00001)和较短的口服喂养天数(MD=-0.79,95%CI=-1.35至-0.22,P=0.006)相关。然而,汇总分析还显示,在l-RAMPS方法中,清扫的淋巴结明显较少(MD=-3.01,95%CI=-5.59~-0.43,P=0.02).
结论:尽管与o-RAMPS相比,l-RAMPS提供了与最小侵入性相关的类似结果,它收集的淋巴结明显减少,这可能对患者的长期生存有潜在的负面影响。L-RAMPS仍处于起步阶段,需要进一步研究以验证其可行性。
BACKGROUND: Laparoscopic radical antegrade modular pancreatosplenectomy (l-
RAMPS) provides a new surgical approach for patients with pancreatic cancers of the body and tail. However, whether it can achieve comparable outcomes to the open
RAMPS (o-
RAMPS) remains an issue.
METHODS: To evaluate the safety and effectiveness of l-
RAMPS, the studies in the databases of Medline, Embase, and the Cochrane Library published before September 13, 2021 were searched and a meta-analysis was performed using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. The perioperative and oncological outcomes were analyzed.
RESULTS: Five retrospective cohorts involving 189 patients were included for final pooled analysis. There were no significant differences in the patients\' operation time, intra-abdominal bleeding rate, intra-abdominal infection rate, mild morbidity (Clavien-Dindo classification = 1), moderate to severe morbidity (Clavien-Dindo classification ≥2), overall morbidity, wound infection rate, pancreatic fistula rate, delayed gastric emptying rate, reoperation rate, length of hospital stay, postoperative mortality, R0 resection rate, and 2-year overall survival between the 2 approaches. Besides, l-
RAMPS was associated with less blood loss (mean difference (MD) = -232.69, 95% confidence interval (CI) = -316.93 to -148.46, P < 0.00001) and shorter days until oral feeding (MD = -0.79, 95% CI = -1.35 to -0.22, P = 0.006). However, the pooled analysis also indicated a significantly fewer lymph nodes dissected (MD = -3.01, 95% CI = -5.59 to -0.43, P = 0.02) in l-RAMPS approach.
CONCLUSIONS: Although l-RAMPS provides similar outcomes associated with benefits of minimal invasiveness compared to o-RAMPS, it harvested significantly fewer lymph nodes which might have potentially negative influence on the patients\' long-term survival. L-
RAMPS is still in the infancy stage and further investigation is needed to verify its feasibility.