In T3 body and tail pancreatic ductal adenocarcinoma (PDAC), radical antegrade modular pancreatosplenectomy (RAMPS) significantly enhances recurrence-free survival (RFS) and overall survival (OS) compared to standard resection.

• RAMPS demonstrated a RFS benefit with an adjusted hazard ratio of 0.46 (p < 0.001) across 695 patients, particularly pronounced in cases with splenic vessel involvement and TP53/KRAS mutations.
• The benefits suggest a potential for a risk-adapted surgical strategy for T3 PDAC, although further prospective validation is necessary.

Surgeons should consider these findings when selecting surgical approaches for patients with T3 PDAC, particularly those with splenic vessel involvement.