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.