Role of Radical Antegrade Modular Pancreatosplenectomy (RAMPS) and Pancreatic Cancer

Purpose Conventional retrograde distal pancreatectomy and splenectomy for pancreatic adenocarcinoma of the body and tail have been associated with high rates of positive margins, low lymph node retrieval, and poor overall survival. Radical antegrade modular pancreatosplenectomy (RAMPS) was introduce...

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Bibliographic Details
Published in:Annals of surgical oncology 2018, Vol.25 (1), p.46-50
Main Author: Chun, Yun Shin
Format: Article
Language:English
Subjects:
Adenocarcinoma
Adenocarcinoma - surgery
Humans
Lymph
Lymph Node Excision
Lymph nodes
Lymphatic system
Margins of Excision
Medicine
Medicine & Public Health
Oncology
Pancreatectomy - methods
Pancreatic cancer
Pancreatic Neoplasms - surgery
Pancreatic Tumors
Splenectomy
Splenectomy - methods
Surgery
Surgical Oncology
Survival
Survival Rate
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Summary:Purpose Conventional retrograde distal pancreatectomy and splenectomy for pancreatic adenocarcinoma of the body and tail have been associated with high rates of positive margins, low lymph node retrieval, and poor overall survival. Radical antegrade modular pancreatosplenectomy (RAMPS) was introduced in 2003 to overcome these limitations. Methods A systematic literature search was performed and articles reviewed to determine if RAMPS or standard distal pancreatectomy and splenectomy offer better survival. The level of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation system. Results Retrospective, single-institution series on RAMPS report mean lymph node counts as high as 24, and negative margin rates between 81 and 100%. Tangential margins are reportedly negative in 94% of patients undergoing RAMPS. Studies comparing RAMPS with standard distal pancreatectomy and splenectomy demonstrate significantly higher lymph node counts, but no improvement in overall survival with RAMPS. Conclusion Despite the theoretic advantages of RAMPS over standard resection, high-level evidence that demonstrates a survival benefit with RAMPS does not currently exist.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-016-5675-4