Evidence map›Paper›PMID 41649934›Full record

ArticleBJS open2025

Radical antegrade modular pancreatosplenectomy versus conventional left pancreatectomy for pancreatic cancer: study protocol for the multicentre randomized clinical RAMPS trial.

Magdalena Holze, Frank Pianka, Martin Wittmann, Ines Photiadis, Solveig Tenckhoff, Anja Sander, Alexandra Balzer, Christina Klose, Rosa Klotz, Mohammed Al-Saeedi and 7 more

Abstract readClinical Trial Protocol
In one paragraph

Article in BJS open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Magdalena HolzeDepartment of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.ORCID 0009-0004-3771-6245
Frank PiankaDepartment of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Martin WittmannDepartment of General, Visceral and Thoracic Surgery, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Ines PhotiadisDepartment of General, Visceral and Thoracic Surgery, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Solveig TenckhoffStudy Center of the German Society of Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Anja SanderInstitute of Medical Biometry, University of Heidelberg, Heidelberg, Germany.
Alexandra BalzerInstitute of Medical Biometry, University of Heidelberg, Heidelberg, Germany.
Christina KloseInstitute of Medical Biometry, University of Heidelberg, Heidelberg, Germany.
Rosa KlotzDepartment of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.ORCID 0000-0003-4123-261X
Mohammed Al-SaeediDepartment of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Martin LoosDepartment of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Christoph W MichalskiDepartment of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Thilo HackertDepartment for General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.ORCID 0000-0002-7012-1196
Patrick HegerDepartment of General, Visceral and Thoracic Surgery, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Markus K DienerDepartment of General, Visceral and Thoracic Surgery, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Markus W BüchlerDepartment of Surgery, Champalimaud Foundation, Lisbon, Portugal.
Felix J HüttnerDepartment of General, Visceral and Thoracic Surgery, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.ORCID 0000-0002-2299-964X

Funding

German Research Foundation DFG 471314494German Research Foundation DFG HU 3127/1-1German Research Foundation DFG PI 1795/1-1
6 · The paper itself

Abstract

backgroundComplete surgical resection (R0 resection) is crucial for overall and disease-free survival in patients with pancreatic cancer undergoing curative surgery. The radical antegrade modular pancreatosplenectomy (RAMPS) procedure was developed to increase achievement of R0 resection margins for tumour resections of the pancreatic body and tail. By extending the posterior dissection plane, a more radical surgical resection can be achieved, as this is the most frequent site of positive margins in conventional left pancreatectomy. RAMPS includes a standardized lymph node dissection and early control of the splenic vessels. Feasibility and safety have already been demonstrated and retrospective studies have shown promising results regarding higher proportions of R0 resection and lymph node counts. To date, high-quality evidence from randomized clinical trials investigating the oncological benefit of RAMPS (that is, resection margin status, disease-free and overall survival) for this patient cohort is lacking.

methodsThe RAMPS trial is a multicentre, randomized clinical, patient and assessor-blinded, confirmatory, superiority trial. In all, 122 patients with an indication for left pancreatectomy due to malignancy of the pancreatic body or tail will be required in each study arm to achieve 80% power at a significance level of 0.025; patients will be randomized to either the RAMPS approach or conventional left pancreatectomy in a 1 : 1 ratio. Patients will be recruited over a 30-month enrolment period. The primary outcome will be the achievement of R0 resections. Secondary outcomes include survival and surgical, functional, and patient-reported outcomes with a 3-year follow-up.

conclusionThe primary objective of the RAMPS trial is to demonstrate the superiority of the RAMPS approach over standard left pancreatectomy in improving the achievement of R0 resection and, consequently, long-term oncological patient outcomes. RAMPS could be established as the new surgical standard for tumour resection in patients with pancreatic cancer in the body or tail of the pancreas. Registration number: DRKS00033031 (https://www.bfarm.de/EN/BfArM/Tasks/German-Clinical-Trials-Register/_node.html).

Indexed as

PancreatectomyPancreatic NeoplasmsSplenectomyDisease-Free SurvivalEquivalence Trials as TopicHumansLymph Node ExcisionMargins of ExcisionMulticenter Studies as TopicRandomized Controlled Trials as Topiconcological surgerypancreasRCTresection margintumour

Identifiers

PMID41649934
PMCPMC12880186

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.