RAMPS Procedure for Adenocarcinoma of the Body and Tail of the Pancreas: How I Do It

Radical antegrade modular pancreatosplenectomy (RAMPS) is performed for cancers of the body and tail of the pancreas which enables surgeons to achieve negative posterior margins more frequently than the traditional left-to-right surgical approach. However, determination of the superior mesenteric artery (SMA) involvement is impossible without first performing irreversible operative steps, despite the fact that SMA involvement generally indicates unresectable disease. SMA first approaches are operative tactics used to determine tumor resectability early during pancreatoduodenectomy. With locally advanced carcinoma of the pancreatic body and tail, early determination of SMA involvement also helps establish whether curative resection is feasible. We describe an inframesocolic SMA first approach as an introductory procedure when treating carcinoma of the pancreatic body and tail. This first approach procedure provides a reliable and safe introduction to RAMPS.