Total mesopancreas excision for pancreatic head cancer: analysis of 120 cases

Abstract

Objective To evaluate the feasibility and safety of total mesopancreas excision (TMpE) in the treatment of pancreatic head cancer. Methods The clinical and pathological data of 120 patients with pancreatic head cancer who had undergone TMpE in our center from May 2010 to January 2014 were retrospectively analyzed. Results The mean operative time was (275.0±50.2) min and the average intra-operative blood loss was (390.0±160.5) mL. Post-operative complications were reported in 45 patients, while no peri-operative death was noted. The specimen margins were measured in three dimensions, and 86 patients (71.6%) achieved R0 resection. Conclusions TMpE is safe and feasible for pancreatic head cancer and is particularly helpful to increase the R0 resection rate.

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

“…Furthermore, several other techniques of TMpE were described in the literature (18)(19)(20)(21)23,(44)(45)(46)(47).…”

“…Several other technical refinements, grouped as "artery-first" approaches, were proposed to better resect PDAC of the pancreatic head, including TMpE (19)(20)(21)45,47,(54)(55)(56)(57)(58)(59).…”

“…In summary, the data from the literature regarding outcomes after PD with TMpE for periampullary malignancies have shown negative resection margins rates between 71.6% and 86%, tumor infiltration of the mesopancreas in 23.1% -82.5% of patients, a median number of harvested lymph nodes between 7.9 and 34, morbidity rates between 33% and 71%, mortality rates between 0% and 5.7%, and median overall survival times between 18.3 months and 20.5 months (17,18,20,(44)(45)(46)54,55,68).…”

“…At this time, although TMpE appears to be widely considered a key point in resection for PDAC of the pancreatic head (15,20,52), however, it is too early to conclude that it has the same oncological value as total mesorectal excision in rectal cancer (70,71).…”

“…This paper aims to discuss the current evidence for the value of TMpE in PDAC. It is worth to mention that in the literature there are used the following terms: total mesopancreas (meso-pancreas) excision (15,(17)(18)(19)(20) and total meso-pancreatoduodenum excision (21,22).…”