根治性顺行模块化胰脾切除术 (RAMPS) 在左侧胰腺癌中得到广泛描述。1.J Hepato-Biliary-Pancreat Sci 29:1156-1165 尽管 R0 切除率理论上有所改善，但其预后优势尚不清楚。 2.J Am Coll Surg 204:244-249 此外，RAMPS 通常在不切除肾上腺的情况下进行，即所谓的前 RAMPS，而将切除范围扩大到肾上腺平面可能会损害围手术期结果。3.HPB 25 :311-319 方法：在一名 70 岁的患者中发现了 40 毫米的胰腺导管腺癌 (PDAC)。肿瘤浸润肾上腺，需要使用机器人后 RAMPS。切开脾血管和胰颈后，沿肠系膜上动脉左缘在矢状面上垂直进行解剖，以识别左肾静脉。在识别出左肾动脉和肾上腺下方后，我们的解剖平面被定向在尾颅轴上。切除的内侧也由肠系膜上动脉和主动脉的左边界界定，后方由肾实质界定。术后病程以生化渗漏为标志。患者于术后第 5 天 (POD) 出院，并于术后第 18 天拔除引流管。病理检查证实 pT2N2 PDAC 切缘阴性，4/18 个淋巴结阳性。机器人平台常规用于胰腺手术。由于其增加的运动程度、灵活性和放大倍数，这种方法可以帮助外科医生识别和控制血管，进行扩大的淋巴结切除术，并找到正确的解剖平面。所有这些要素对于性能良好的后 RAMPS 都至关重要。© 2024。外科肿瘤学会。

Radical antegrade modular pancreato-splenectomy (RAMPS) has been largely described in left-sided pancreatic cancers.1.J Hepato-Biliary-Pancreat Sci 29:1156-1165 Its prognostic advantage is not clear, although a theoretical improvement in R0 resection rate has been shown.2.J Am Coll Surg 204:244-249 Furthermore, RAMPS is usually carried out without adrenal gland removal, the so-called anterior RAMPS, while extending the resection to the adrenal plane could impair perioperative outcomes.3.HPB 25:311-319 METHODS: A 40 mm pancreatic ductal adenocarcinoma (PDAC) was found in a 70-year-old patient. Tumor infiltrates the adrenal gland and a robotic posterior RAMPS was indicated.After sectioning the splenic vessels and the pancreatic neck, the dissection was directed vertically in a sagittal plane along the left border of the superior mesenteric artery to identify the left renal vein. Our dissection plane was then directed on a caudo-cranial axis, after identification of the left renal artery and below the adrenal gland. The resection was also delimitated medially by the left borders of the superior mesenteric artery and the aorta, and posteriorly by the renal parenchyma. Postoperative course was marked by a biochemical leak. The patient was discharged on postoperative day (POD) 5 and the drain removed at POD 18. Pathological examination confirmed a pT2N2 PDAC with negative margins, with 4/18 positive nodes.The robotic platform is routinely employed in pancreatic surgery. Thanks to its increased degree of movement, its dexterity, and the magnification, this approach can help surgeons with vascular identification and control, in performing extended lymphadenectomies, and finding the correct planes of dissection. All these elements are crucial in a well-performed posterior RAMPS.© 2024. Society of Surgical Oncology.