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

Popescu, Irinel; Dumitraşcu, Traian

doi:10.21614/chirurgia.113.3.335

Cited by 6 publications

(3 citation statements)

References 53 publications

(104 reference statements)

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“…PD with total mesopancreas excision (TMpE) was reported to be associated with decreased EBL, increased number of harvested lymph nodes and negative resection margins rates. However, evidences of improved survivals in PDAC patients with TMpE were limited [28]. Wu et al retrospectively analyzed 120 patients with pancreatic head cancer who received PDs with TMpE and revealed a 71.6% of R0 resection [29].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy

Tian¹,

Wang²,

Hua³

et al. 2020

BMC Surg

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Background: The safety of total laparoscopic pancreaticoduodenectomy still remains controversial. Laparoscopic assisted pancreaticoduodenectomy (LAPD) may be an alternative selection. The purpose of the present study is to compare a consecutive cohort of LAPD and open pancreaticoduodenectomy (OPD) from a single surgeon. Methods: A comparison was conducted between LAPD and OPD from January 2013 to December 2018. Perioperative outcomes and short-term oncological results were compared. Univariate and multivariable analyses were performed to determine associations among variables. Results: 133 patients were enrolled, 36 patients (27.1%) underwent LAPD and 97 (72.9%) underwent OPD. No 30day and 90-day mortality occurred. LAPD was associated with decreased intraoperative estimated blood loss (300 versus 500 ml; P = 0.002), longer operative time (372 versus 305 min; P < 0.001) compared with OPD. LAPD had a conversion rate of 16.7%, and wasn't associated with an increased grade B/C pancreatic fistula rate, major surgical complications, intraoperative blood transfusion, reoperation rate or length of hospital stay after surgery. In the subset of 58 pancreatic ductal adenocarcinomas, R0 resection rate, median total harvested lymph node or lymph nodes ≥12 did not differ between the two groups. Conclusion: LAPD could be performed with non-inferior short-term perioperative and oncologic outcomes achieved by OPD in selected patients.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy

Tian¹,

Wang²,

Hua³

et al. 2020

BMC Surg

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“…The local recurrence rate can reach 80% within the first year after surgery, implying that most pancreaticoduodenectomies are not actually curative [23]. With advances in pathological techniques, it has been found that relapse most commonly occurs in the soft tissues behind the pancreatic head, and that curative resection (R0) is not actually achieved in 20-86% of pancreatic head cancer patients [17]. The poor prognosis after surgery for pancreatic cancer has mainly been attributed to early lymph node involvement, as well as a strong tendency of this cancer to infiltrate the retropancreatic tissues and spread along the peripancreatic neural plexuses 1 3 [7].…”

Section: Introductionmentioning

confidence: 99%

The mesopancreas and pancreatic head plexus: morphological, developmental, and clinical perspectives

Nagakawa

Ren

et al. 2020

Surg Radiol Anat

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Purpose Total mesopancreas excision has been found to be helpful for increasing no residual tumor resection rate and improving the prognosis of pancreatic cancer. This study analyzed the relationships among the mesopancreas and pancreatic head plexus from the morphological, developmental, and clinical perspectives. Methods Twenty-four cadavers were employed. The upper abdominal viscera were resected en-bloc with the hepatoduodenal ligament, abdominal aorta, and nerve plexuses, and the innervation of the pancreas was dissected. Ten additional cadavers were used for histological examination of the pancreatic head and neck, part of the duodenum, the superior mesenteric artery (SMA) and its surrounding tissues, and the related arteries and veins. Results As results, cross-sections of the SMA revealed 6-9 layers of membranous structures resembling the layers of an onion, and the nerve fibers of the superior mesenteric plexus ran between the layers. Loose areolar tissue, adipose tissue, and lymphatics existed between the SMA and the pancreatic head/uncinate process, along with abundant thin blood vessels and capillaries, but very few nerves were found approaching the pancreas. Several parallel layers of collagen fibers (so-called Treitz's fusion fascia) existed between the dorsal aspect of the pancreatic head and the aortocaval plane. ConclusionThe mesopancreas was continuous and connected with the para-aortic area. It may be better termed the mesopancreatoduodenum than the mesopancreas, as the duodenum-pancreas-SMA forms a complex morphological, developmental, functional, and pathological structure.

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“…While the mesopancreatic (MP) fat surrounding the pancreatic head has been studied in detail [ 7 , 22 – 26 ], it remains unknown if the mesopancreatic fat surrounding the pancreatic body and tail is equally affected in dPDAC patients undergoing curative resection. It also remains unknown if the mesopancreatic infiltration status affects surgical margin clearances.…”

Section: Introductionmentioning

confidence: 99%

Defining distal splenopancreatectomy by the mesopancreas

Safi,

Alexander,

Neuhuber

et al. 2024

Langenbecks Arch Surg

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Background The implementation of the pathologic CRM (circumferential resection margin) staging system for pancreatic head ductal adenocarcinomas (hPDAC) resulted in a dramatic increase of R1 resections at the dorsal resection margin, presumably because of the high rate of mesopancreatic fat (MP) infiltration. Therefore, mesopancreatic excision (MPE) during pancreatoduodenectomy has recently been promoted and has demonstrated better local disease control, fueling the discussion of neoadjuvant downsizing regimes in MP + patients. However, it is unknown to what extent the MP is infiltrated in patients with distal pancreatic (tail/body) carcinomas (dPDAC). It is also unknown if the MP infiltration status affects surgical margin control in distal pancreatectomy (DP). The aim of our study was to histopathologically analyze MP infiltration and elucidate the influence of resection margin clearance on recurrence and survival in patients with dPDAC. Furthermore, the results were compared to a collective receiving MPE for hPDAC. Method Clinicopathological and survival parameters of 295 consecutive patients who underwent surgery for PDAC (n = 63 dPDAC and n = 232 hPDAC) were evaluated. The CRM evaluation was performed in a standardized fashion and the specimens were examined according to the Leeds pathology protocol (LEEPP). The MP area was histopathologically evaluated for cancerous infiltration. Results In 75.4% of dPDAC patients the MP fat was infiltrated by vital tumor cells. The rates of MP infiltration and R0CRM– resections were similar between dPDAC and hPDAC patients (p = 0.497 and 0.453 respectively). MP– infiltration status did not correlate with CRM implemented resection status in dPDAC patients (p = 0.348). In overall survival analysis, resection status and MP status remained prognostic factors for survival. In follow up analysis. surgical margin clearance in dPDAC patients was associated with a significant improvement in local recurrence rates (5.2% in R0CRM– resected vs. 33.3 in R1/R0CRM + resected, p = 0.002). Conclusion While resection margin status was not affected by the MP status in dPDAC patients, the high MP infiltration rate, as well as improved survival in MP– dPDAC patients after R0CRM– resection, justify mesopancreatic excision during splenopancreatectomy. Larger scale studies are urgently needed to validate our results and to study the effect on neoadjuvant treatment in dPDAC patients.

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

Cited by 6 publications

References 53 publications

Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy

Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy

The mesopancreas and pancreatic head plexus: morphological, developmental, and clinical perspectives

Defining distal splenopancreatectomy by the mesopancreas

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