Efficacy comparison of radical antegrade modular pancreatosplenectomy versus conventional distal pancreatectomy in the treatment of left-sided pancreatic cancer: a meta-analysis and systematic review.

OBJECTIVE

To systematically evaluate the efficacy and safety of radical antegrade modular pancreatosplenectomy (RAMPS) versus conventional distal pancreatectomy (CDP) for left-sided pancreatic cancer.

METHODS

Computerized searches were conducted in PubMed, Embase, Cochrane Library, CNKI, Wanfang Data and other Chinese and English databases to collect studies comparing RAMPS with CDP for left-sided pancreatic cancer published from January 2003 to October 2025. Two researchers independently completed literature screening and data extraction; the ROBINS-I tool was used for bias risk assessment; RevMan 5.4.1 software was used for effect size combination, and R software was used for sensitivity analysis and publication bias analysis.

RESULT: A total of 21 studies were included, involving 2,591 patients, among which 9 were propensity score-matched (PSM) studies. The results of the meta-analysis showed that compared with CDP, RAMPS could significantly increase the R0 resection rate (RR = 1.10, 95% CI: 1.03-1.18, P = 0.007) and the number of lymph nodes dissected (MD = 3.58, 95%CI 1.66 - 5.50, P<0.001). However, substantial heterogeneity was noted for these outcomes (I2 = 72%/93%). No significant differences were found in operative time, blood loss, hospital stay, overall complication rates, or perioperative mortality. Crucially, there were no significant differences in overall survival (HR = 0.93, 95% CI: 0.76-1.13, P = 0.46) or disease-free survival (HR = 1.01, 95% CI: 0.77-1.33, P = 0.92) between the two procedures.

CONCLUSION

For left-sided pancreatic cancer, RAMPS may offer advantages in local tumor control and surgical radicality; however, such advantages have not been shown to translate into meaningful improvements in survival outcomes.