title: Role of Radical Antegrade Modular Pancreatosplenectomy (RAMPS) and Pancreatic Cancer.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Despite the theoretic advantages of RAMPS over standard resection, high-level evidence that demonstrates a survival benefit with RAMPS does not currently exist.
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. yschun@mdanderson.org.
authors.forename: Yun Shin
authors.initials: YS
authors.lastname: Chun
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D000072662:Margins of Excision; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D015996:Survival Rate