Mesopancreas in Pancreatic Cancer: Where do We Stand – Review of Literature

Abstract

Pancreatic cancer is associated with poor prognosis and surgery remains the main modality of treatment. Negative resection margin is an important prognostic factor for survival. Retropancreatic margin or the medial margin is the most common site of positive resection margin. Mesopancreas was proposed in analogy with mesorectum, which is considered as a fusion fascia formed embryologically during the development of pancreas. This mesopancreas lies posterior to the pancreas and contains pancreaticoduodenal vessels, lymphatics, nerve plexus and loose areolar tissue. Various technical modifications were proposed for better dissection of mesopancreas like posterior approach and artery first approach. There is an increased rate of R0 resection by these technical modifications but whether this will turn to increase in survival rates is yet to be established.

Perioperative outcomes of pancreaticoduodenectomy: Superior mesenteric artery first approach in Rajavithi Hospital, Thailand

“…11 The concept of mesopancreas excision was proposed in 2007. 9,10 The benefits of this method has been reported in many studies.…”

“…Many studies have focused on periadventitial dissection of the SMA based on the belief that a free mesopancreas margin might be a substantial factor in decreasing local recurrence. 11 The concept of mesopancreas excision was proposed in 2007. 12 The principle is similar to the total mesorectal excision in rectal carcinoma.…”

What is the Value of Total Mesopancreas Excision in Pancreatic Ductal Adenocarcinoma? Current Evidence of the Literature

“…nodes or perineural dissection are considered factors associated with local recurrence after resection for PDAC (23). Furthermore, local recurrence occurs more frequently in patients with positive resection margins (26).…”

“…Recurrence is a common event after curative-intent surgery for PDAC, mainly related to incomplete removal at the site of resection margins; medial/ superior mesenteric margins are the most often positive. The concept of total meso-Recurrence after curative-intent surgery for PDAC is unfortunately a common event -75% -100% of patients (15,(23)(24)(25); a local recurrence is the first reported event for most patients with recurrent PDAC(7;26). Incomplete lymph pancreas excision (TMpE) in PDAC was proposed in analogy to the concept of total mesorectal excision for rectal cancer, to better control loco-regional recurrence.…”

The concept and controversy of retroperitoneal nerve dissection in pancreatic head carcinoma (Review)

“…Viewed from the perspective of embryology, due to a duodenal loop, the 'meso' disappears during embryonic development (57). The embryonic mesentery facilitates the pancreatic germ attachment to the abdominal wall, thus, forming the pancreatic mesopancreas.…”