Effect of minimally invasive or open radical antegrade modular pancreatosplenectomy on pancreatic cancer: a multicenter prospective propensity-score matched analysis

Background: We aimed to determine the safety and effectiveness of minimally invasive (MI) vs. open (O) radical antegrade modular pancreatosplenectomy (RAMPS) in patients with distal pancreatic cancer. Advances in MI surgery have enhanced postoperative recovery, but the safety and oncological effectiveness of MI-RAMPS has not been validated. Materials and methods: A multicenter propensity score matching (PSM) study was conducted across eight centers in China from June 2020 to December 2023. Adults with resectable or borderline resectable distal pancreatic cancer who underwent MI-RAMPS or O-RAMPS were included. PSM was performed in a 1:1 ratio with a caliper width of 0.06. The primary outcome was the postoperative hospital stay (PHS). Secondary outcomes included R0 resection rates, postoperative complications, disease-free survival (DFS), and overall survival (OS). Results: Overall, 232 patients were included in the study (MI-RAMPS: 149, O-RAMPS: 83). Before matching, MI-RAMPS was associated with a lower rate of combined vascular resection (5.4% vs 14.5%, P = 0.018), fewer lymph nodes harvested (median 9 vs 13, P = 0.030), and a shorter PHS (median 9 vs 10 days, P = 0.013). After PSM, 69 patients were matched in each group. MI-RAMPS remained associated with a shorter PHS (median 9 vs 10 days, P = 0.005), with no significant differences in severe complication rates (2.9% vs 2.9%, P = 1.000), number of lymph nodes harvested (median 9 vs 12, P = 0.142), and R0 resection rate (95.7% vs 92.8%, P = 0.718). The MI-RAMPS group required a longer operative time (median 270 vs 240 min, P <0.001). The DFS and OS was comparable between both groups (median DFS: 18.9 vs 12.6 months, P = 0.316; median OS: 28.6 vs 34.3 months, P = 0.483). Conclusion: MI- RAMPS shortened PHS compared to O-RAMPS, with no difference in postoperative complications or oncologic outcomes, highlighting its feasibility for patients with distal pancreatic cancer.