Total mesopancreas excision for the treatment of pancreatic head cancer

Abstract

Mesopancreas is a controversial structure. This study aimed to explore the anatomical characteristics of the mesopancreas, define the range of the total mesopancreas excision (TMpE), and evaluate the feasibility, safety and effectivity of TMpE in the treatment of pancreatic head cancer. The clinical and pathological data of 58 consecutive patients undergoing TMpE for pancreatic head carcinoma from January 2013 to December 2015 were analyzed prospectively. The perioperative morbidity, mortality and clinical outcomes of patients undergoing TMpE were compared with the patients undergoing conventional pancreaticoduodenectomy. The mesopancreas was located in the retropancreatic area, extending from the head, neck, and uncinated process of pancreas to the aorto-caval groove, in which there were loose areolar tissue, adipose tissue, nerve plexus, lymphatic and capillaries. We observed significantly higher R0 rate (94.8% vs. 81.4%, P=0.035), more lymph nodes (16.2 vs. 11.4, P=0.000), lower total and local recurrence rate (half-year local recurrence rate 7.8% vs. 23.7%, P=0.036, one-year 18.2% vs. 39.5%, P=0.018) and longer disease-free survival (16.9 vs. 13.4 months, P=0.044) in TMpE group than in control group. In conclusion, mesopancreas is different from mesorectum because there is no fascial envelop or anatomical boundary in this area. TMpE could be safely and feasibly performed for the treatment of pancreatic head cancer to increase the R0 resection rate and improve the clinical outcomes.

Real robotic total mesopancreas excision (TMpE) assisted by hanging manoeuver (HM): Standardised technique

“…Even though the debate on extended lymphadenectomy during PD is still open and controverted, with many authors not recommending it, 17 , 18 many other authors insist on the real importance of TMpE in order to achieve an R0 resection 19 ,. 20 Duodenopancreatic junction tumours commonly grow and spread towards the retropancreatic tissues. In addition, the infiltration of the periarterial nerve plexus that surrounds the superior mesenteric artery is not an exception 21 .…”

Progress in 9,10-distyrylanthracene derivatives with aggregation-induced emission

“…可见波长范围的AIE材料体系 [11] . 其中, 二苯乙烯基蒽 (9,10-distyrylanthracene, DSA)及其衍生物具有结构简 单、易合成(合成路线如图1所示)、性能优异等优点, 具有广泛的应用潜力 [12] . 本文重点介绍了具有AIE性 质的DSA衍生物及其在高效固态发光、刺激响应、生 物成像和生物与化学传感等领域的研究进展.…”

“…DSA分子和化合物17~19可由再沉淀法形 成微纳米晶 [18] . [18] (网络版彩图) 图 6 (a) 化合物20作为发光层的OLED的电流效率和功率效率, 插图为器件的电流密度-电压-亮度参数; (b) 器件的电致发光 光谱和色坐标 [21] (网络版彩图) DSA衍生物具有良好的刺激响应性质 [12] , 在此分 类介绍了图7中的刺激响应DSA衍生物.…”

“Mesopancreas-first” radical resection of pancreatic head cancer following the Cattell–Braasch–Valdoni maneuver: Appreciating the legacy of pioneers in visceral surgery

“…Respectively, the mesopancreas during embryogenesis rotates from the right-posterior to the left and forms a spiral around the SMA, becoming the central structure of mesenteric distortion [12]. This anatomic complexity is further compounded by the fact that during embryogenesis the mesopancreas fuses with the retroperitoneal structures, forming a complete and boundless anatomic continuum throughout the para-aortic area [9,23]. Hence, this creates a complicated tridimensional vascular anatomy around the ligament of Treitz, the proximal mesojejunum, and the pancreaticoduodenal complex.…”