HPB SO69 - Comparison of radical antegrade modular pancreatosplenectomy with standard pancreatosplenectomy for left sided pancreatic cancer

Abstract Background Long term survival of patients undergoing distal pancreatosplenectomy for left sided pancreatic cancer has not been satisfactory owing to inability to achieve negative resection margins. Radical antegrade modular pancreatosplenectomy (RAMPS) has been designed to achieve better margin resection and better lymph node clearance compared to the standard distal pancreatosplenectomy (SDP) for left sided pancreatic cancer. This results in better oncological outcomes and patient survival rates. The aim of this study was to compare clinical outcomes from RAMPS and SDP. Method Literature search was performed to identify studies published in Pubmed, Embase, Cochrane library and google search. 13 Studies comparing RAMPS versus standard method of distal pancreatecetomy were included in the final meta-analysis. Revman 5.4 was used to perform the analysis and random effects model was used with results shown on forest plot. A total of 1450 patients were enrolled in the meta analysis with 685 in RAMPS and 765 patients in SDP group. R0 resection rate, recurrence rate, better overall survival and number of harvested lymph nodes were taken as primary outcomes. Results RAMPS was associated with better overall survival than SDP (HR-0.62, 95% CI - 0.38-0.91, p=0.03). The recurrence rate (OR-0.68, 95% CI 0.47-0.97, p=0.04) was significantly less. R0 resection rate was higher in RAMPS but did not reach statistical significance (OR-1.47 CI0.93-2.3, p=0.10). Complications notably pancreatic fistula Showed favourable results in RAMPS along with other variables such as hospital stay, operative stay and blood loss but didn’t reach statistical Significance. Conclusion This study clearly signifies the importance of RAMPS being able to achieve higher R0 resection rate as well as less complications which results in better surgical and long term clinical outcomes for the patients. With more expertise and surgical training, this novel procedure promises to be a more safer and feasible technique than the conventional pancreatosplenectomy.