Dados do Trabalho

Título

Laparoscopic posterior radical antegrade modular pancreatosplenectomy (R.A.M.P.S) for resectable adenocarcinoma of the pancreatic body

Introdução

Pancreatic cancer is an agressive tumor and difficult to be diagnosed at an early stage. According to INCA (Instituto Nacional do Câncer - Brazil) the pancreatic cancer is responsable for 1% of cancer diagnosis in Brazil and 5% of cancer related deaths.
We are a large cancer center in São Paulo- Brazil and were presented with a female patient, 54 years old with BRCA 1 mutation that had a hypovascular solid nodule in the pancreas body measuring 25 x 22 mm with splenic artery contact, peripancreatic fat densification and contact with renal fascia .
After a multidisciplinary meeting the patient treatment iniciated with neoadjuvant chemoterapy followed by a posterior RAMPS (radical antegrade modular pancreatosplenectomy) laparoscopic procedure.

Objetivo

Present a surgical video of a challenging case, the surgery development as well as the outcome.

Método

Surgical detailed video of a posterior RAMPS laparoscopic procedure.

Resultados

The RAMPS procedure was first reported in 2003 by Strasberg and was designed to establish an operation with oncologic safety both with respect to the dissection planes used to achieve negative margins as well as the extent of lymph node dissection, aiming to improve patient outcomes.
The patient presented had a hypovascular solid nodule in the pancreas body with splenic artery contact, peripancreatic fat densification and contact with renal fascia. Due to this presentation was decided that the best surgical procedure would be a laparoscopic posterior RAMPS.
The posterior RAMPS procedure consists in the ressection above the left renal vein plan with the removal of the left adrenal gland and Gerota fascia.
The surgery was a succes and the patient was discharged in the fifth post-operative day.

Conclusão

The RAMPS procedure is a good option when faced with a posterior distal tumor of the pancreatic body aiming to have better surgical margin and a extensive lymph node dissection; we present a feasible laparoscopic surgery with good outcome in a specialized cancer center.

Vídeo

https://youtu.be/HgZS71_Bb_A