Efficacy and safety of radical antegrade modular pancreatosplenectomy versus standard radical pancreatosplenectomy for pancreatic body/tail cancer: A systematic review and meta-analysis.

Abstract

To compare the efficacy and safety of radical antegrade modular pancreatosplenectomy with standard radical pancreatosplenectomy in the treatment of pancreatic body and tail cancer. A comprehensive literature search was conducted in the PubMed, EMBASE, and Web of Science databases from January 2003 to July 2025. Pooled odds ratios, hazard ratios, or mean differences were calculated with 95% CIs. The analysis was performed using RevMan 5.4.1 and R 4.3.0. Sixteen studies involving 2,136 patients were included. The pooled results revealed no significant difference in overall survival (HR, 0.87; 95% CI, 0.71-1.07; P = .18) or disease-free survival (HR, 0.85; 95% CI, 0.62-1.19; P = .35) between the 2 groups. However, the radical antegrade modular pancreatosplenectomy procedure was associated with significantly more lymph nodes being harvested (MD, 3.83; 95% CI, 2.22-5.42; P < .00001) and a higher rate of R0 resection (OR, 1.51; 95% CI, 1.19-1.91; P = .0007) than the standard radical pancreatosplenectomy procedure. The radical antegrade modular pancreatosplenectomy technique was not associated with improved overall or disease-free survival compared with the standard technique; however, the former achieved superior lymph node harvesting and R0 resection rates without increasing postoperative complications. Its technical complexity necessitates judicious application in selected patients.