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ANTERIOR RADICAL ANTEGRADE MODULAR PANCREATOSPLENECTOMY TECHNIQUE: DESCRIPTION OF A MINIMALLY INVASIVE APPROACH FOR DISTAL PANCREATIC ADENOCARCINOMA.
Radical antegrade modular pancreatosplenectomy (RAMPS) was first reported by Strasberg in 2003 in order to achieve negative posterior resection margins and to completely remove the N1 lymph nodes in adenocarcinomas of the body and tail of the pancreas. In this video we present a case of a 60-year-old female patient who had an acute pancreatitis episode two months prior the investigation. Further investigation showed a 1,3cm lesion on pancreatic body suspected for primary tumor. She was scheduled for a MIS resection and a RAMPS procedure was planned. Procedure starts with the division of the neck of the pancreas and splenic vessels, followed by lymph node and perineural plexus dissection from the celiac axis downward to the SMA. The dissection is continued laterally anterior (anterior RAMPS), based on the resection plane that is just behind the anterior renal fascia considering that the tumor did not penetrate the posterior capsule of the pancreas on preoperative CT scans. The procedure lasted for 04 hours and patient was discharged on POD four. The pathology report showed a pancreatic ductal adenocarcinoma measuring 3.8 cm with negative margins and 2 of 34 dissected positive lymph nodes. The benefits of RAMPS include early vascular control, improved visualization of the posterior plane of dissection, higher lymph node yield and negative tangential margin rates. Although complex, it is safe and feasible in reference centers.
Anterior RAMPS, pancreatic adenocarcinoma, anterior radical antegrade modular pancreatosplenectomy
ALEX ALBUQUERQUE LINS BARBOSA, JACQUELINE NUNES MENEZES, SILVIO MELO TORRES, IGOR CORREIA FARIAS, HEBER SALVADOR CASTRO RIBEIRO, ANDRE LUIZ GODOY, ALESSANDRO LANDSKRON DINIZ, DANTE ALTENFELDER SILVIA, WILSON LUIZ DA COSTA JR, FELIPE JOSE FERNANDEZ COIMBRA