title: Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure.
abstract: BACKGROUND
  The radical antegrade modular pancreatosplenectomy (RAMPS) procedure is a modification of standard distal pancreatosplenectomy. It was designed to provide the operative approach developed for cancers of the head of the pancreas to cancers of the body and tail of the pancreas, particularly with respect to the extent of node dissection and emphasis on obtaining microscopically negative tangential margins. The purpose of this report is to provide long-term survival results.
  
  
  METHODS
  Forty-seven patients had RAMPS between 1999 and 2008. The decision to perform anterior vs posterior RAMPS was based on the position of the tumor as assessed by preoperative computed tomograms. Patients were entered in a prospective database and followed at intervals.
  
  
  RESULTS
  Thirty-two patients had anterior RAMPS and 15 had posterior RAMPS. Twenty-four patients had resection of 33 organs in addition to the left adrenal gland in the posterior RAMPS. Specimens were inked in the operating room. Mean tumor size was 4.4 cm. Negative tangential margins were obtained in 89% of specimens. Overall, the R0 rate was 81%. Mean lymph node count was 18. There were no 30-day or in-hospital mortalities. Mean and median follow-up times of living patients were 44.4 and 26.4 months. Median survival was 26 months and 5-year overall actuarial survival was 35.5%. The actual survival of 23 patients whose surgery was performed more than 5 years before the time of analysis was 30.4%.
  
  
  CONCLUSIONS
  RAMPS is associated with high negative tangential margin rates and very satisfactory survival rates for this aggressive tumor.
authors.affiliation: Section of Hepato-Pancreato-Biliary Surgery, Washington University in St Louis, St Louis, MO 63110, USA.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Mitchem
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hamilton
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
authors.forename: David C
authors.initials: DC
authors.lastname: Linehan
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D011446:Prospective Studies; D013156:Splenectomy / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome