RAMPS – Surgical Treatment for a Pancreatic Tumor

Abstract

Background: Radical antegrade modular pancreatosplenectomy (RAMPS) is not the standard procedure for cancers of the body and tail of the pancreas but this approach provides improvement in the establishment of an operation with oncologic rationales both for the dissection planes used to achieve negative margins and the extent of lymph node dissection. The authors present a clinical case report. Methods: The authors present a clinical case report. Results: 55-year-old lady, without comorbidities, felt epigastric pain and noted weight loss (10Kg) for a month. Had a CT scan that showed a pancreatic body mass (4x2cm) with splenic vessels encasement and segmental involvement of splenoportal confluent. The case was discussed in a multidisciplinary meeting and decided with surgery. We performed a radical antegrade modular pancreatosplenectomy with side wall portal ressection. This procedure has complicated with the development of diabetes and a type b pancreatic fistula (conservative treatment). Pathology showed an invasive pancreatic ductal adenocarcinoma (6.5cm) with perineural invasion and metastases in 9 of 27 identified lymph nodes (pT4N2). Conclusion: RAMPS procedure for lesions of the body and tail of the pancreas can retrieve significantly more lymph nodes than standard distal pancreatectomy and splenectomy and, therefore, improving tumor staging and outcome.