TITLE:

RAMPS as the procedure of choice for adenocarcinoma of body of Pancreas;

A case report and review of literature

ABSTRACT:
BACKGROUND: A pancreatic adenocarcinoma has well defined specific surgical approaches
based on the location of the neoplasm. A Distal Pancreatico Splenectomy (DPS) is regarded as a
standard operation for tumors of the body and tail of pancreas. However, the long-term survival
of these patients remains unsatisfactory, with a median survival time of 10–28 months and a 5-
year overall survival of 6–30% with a standard DPS. Strasberg et al., in 2003, modified the DPS
surgery and proposed a right to left surgical approach to improve the rate of R0 resection as well
as a satisfactory lymphadenectomy, and named it
Radical Ante grade Modular Pancreatico Splenectomy (RAMPS). This procedure was designed
to establish oncologic safety both with respect to the dissection planes used to achieve negative
margins as well as the extent of lymph node dissection, thereby improving patient outcomes.

CASE REVIEW: We hereby report a case of an adenocarcinoma at the junction of neck and
body of pancreas in a 50 year old female and the outcomes obtained with RAMPS procedure for
this case. The tumor was a 5*4 cm in its dimensions and most of it was situated in the body of
pancreas. An anterior RAMPS was performed in view of non- involvement of posterior capsule
of pancreas on imaging. Patient recovered uneventfully after the procedure and is on regular
follow up. She was subjected to six cycles of adjuvant chemotherapy post-surgery. There was no
recurrence for a year after surgery and there were no other long term complications, except
development of Diabetes mellitus, which is being managed by exogenous insulin. The results
obtained in this case are satisfactory in view of oncological outcomes. This review article is
aimed at comparing outcomes related to RAMPS and DPS as the procedures for tumors of body
and tail of pancreas.

CONCLUSION:

The RAMPS procedure is safe and attains oncological superiority to the standard procedure for
the treatment of left-sided pancreatic cancer.

A systemic review and meta-analysis of the current retrospective data comparing RAMPS and
the standard procedure are necessary to implicate the role of RAMPS in the treatment of left-
sided pancreatic cancer.