Mesopancreas: A boundless structure, namely R1 risk in pancreaticoduodenectomy for pancreatic head carcinoma

Peparini, Nadia; Chirletti, Piero

doi:10.1016/j.ejso.2013.10.012

Cited by 45 publications

(27 citation statements)

References 37 publications

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“…According to these names, we would relate it with margin locates at dorsal to the pancreatic head, adjacent to superior mesenteric artery, and might contain the mesopancreas. The definition of mesopancreas differs in different studies [16–21]. However, we can find some similarities between SMA margin and mesopancreas.…”

Section: Resultsmentioning

confidence: 72%

Superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic adenocarcinoma

Liu

Tian

et al. 2016

Oncotarget

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The aim of this study is trying to describe more details of superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, to evaluate biological and prognostic implications of tumor budding in this margin, and to provide more evidence for evaluation of R0 surgery in pancreaticoduodenectomy. 46 patients in 5-years period are included in this study. Immunochemistry and immunofluorescence are used to analyze tumor budding and epithelial–mesenchymal transition. Superior mesenteric artery margin might be described from four aspects including location, gross appearance, microscopic appearance and tumor budding. We find that 1mm rule for R1 surgery is more appropriate to predict prognosis (P = 0.009) than 0mm rule (P = 0.141). Expression of cytokeratin in tumor budding is significantly lower than primary tumor (P = 0.001), and it suggests that tumor budding may participate the procedure of epithelial–mesenchymal transition. High-grade tumor budding and decreasing cytokeratin of tumor budding correlate with distant metastasis and has negative influence on prognosis. So superior mesenteric artery margin might be not only an area that tumor cells may invade, but also a pathway for distant metastasis. It is necessary to evaluate superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic cancer.

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Section: Resultsmentioning

confidence: 72%

Superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic adenocarcinoma

Liu

Tian

et al. 2016

Oncotarget

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“…Connective tissue between the pancreatic head and the SMA plexus has been defined as pancreatic head plexus II (plPh‐II), but is also known as ‘mesopancreas’10, 21, 22 or ‘meso‐pancreatoduodenum’ 23. However, from an anatomical point of view, this nomenclature is controversial 24.…”

Section: Discussionmentioning

confidence: 99%

“…The dissected margin of plPh‐II is reported to be the most favorable positive margin site for PDAC of the pancreatic head 3, 4, 5, 6. Therefore, complete clearance of the connective tissue around the SMA during PD is considered to increase R0 rate and improve the survival rate of patients with PDAC located in the pancreatic head 8, 9, 10, 12, 13, 21, 22, 23, 25. Furthermore, the artery‐first approach aims to assess resectability status before irreversible steps in the operation and reduce blood loss as a result of early ligation of the vessels to the pancreatic head.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Hirono

Kawai

Okada

et al. 2017

Annals of Gastroent Surgery

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Mesenteric approach is an artery‐first approach during pancreaticoduodenectomy (PD). In the present study, we evaluated clinical and oncological benefits of this procedure for pancreatic ductal adenocarcinoma (PDAC) of the pancreas head. Between 2000 and 2015, 237 consecutive PDAC patients underwent PD. Among them, 72 experienced the mesenteric approach (mesenteric group) and 165 the conventional approach (conventional group). A matched‐pairs group consisted of 116 patients (58 patients in each group) matched for age, gender, resectability status, and neoadjuvant therapy. Surgical and oncological outcomes were compared between the two groups in unmatched‐ and matched‐pair analyses. Intraoperative blood loss was lower in the mesenteric group than in the conventional group in both resectable PDAC (R‐PDAC) and borderline resectable PDAC (BR‐PDAC) on unmatched‐ and matched‐pairs analyses (R‐PDAC, unmatched: 312.5 vs 510 mL, P=.008; matched: 312.5 vs 501.5 mL, P=.023; BR‐PDAC, unmatched: 507.5 vs 935 mL, P<.001; matched: 507.5 vs 920 mL, P=.003). Negative surgical margins (R0) and overall survival (OS) rates in the mesenteric group were better in R‐PDAC patients (R0 rates, unmatched: 100% vs 87.7%, P=.044; matched: 100% vs 86.7%, P=.045; OS, unmatched: P=.008, matched: P=.021), although there were no significant differences in BR‐PDAC patients. Mesenteric approach might reduce blood loss by early ligation of the vessels to the pancreatic head. Furthermore, it might increase R0 rate, leading to improvement of survival for R‐PDAC patients. However, R0 and survival rates could not be improved only by the mesenteric approach for BR‐PDAC patients. Therefore, effective multidisciplinary treatment is essential to improve survival in BR‐PDAC patients.

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“…The term MP seems to replace or rather include the classical term of retroportal lamina (RPL), retroperitoneal/posteromedial margin, or retropancreatic capsule, which has a frontal disposition between the pancreas and the SMA [10, 14, 15, 20, 21]. The MP is of great interest with respect to curative resection in malignancies since it is the primary site for R 1 resection [21, 43]. In our series, the positive resection margins-R 1 (5 patients) were associated to borderline resectable pancreatic head cancers and extended to uncinate, but the rate (14%) is lower than that reported in the literature for similar cases (18–24%) [11, 44].…”

Section: Discussionmentioning

confidence: 99%

Hind Right Approach Pancreaticoduodenectomy: From Skill to Indications

Georgescu¹,

Ursulescu²,

Grigorean

et al. 2014

Gastroenterology Research and Practice

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Background. Pancreaticoduodenectomy is the potentially curative treatment for malignant and several benign conditions of the pancreatic head and periampullary region. While performing pancreaticoduodenectomy, early neck division may be impossible or inadequate in case of hepatic artery anatomic variants, suspected involvement of the superior mesenteric vessels, intraductal papillary mucinous neoplasm, and pancreatic head bleeding pseudoaneurysm. Our work aims to highlight a particular hind right approach pancreaticoduodenectomy in selected indications and assess the preliminary results. Methods. We describe our early hind right approach to the retropancreatic vasculature during pancreaticoduodenectomy by mesopancreas dissection before any pancreatic or digestive transection. Results. We used this approach in 52 patients. Thirty-two had hepatic artery anatomic variant and 2 had bleeding pancreatic head pseudoaneurysm. The hepatic artery variant was preserved in all cases out of 2 in which arterial reconstruction was performed. In nine patients with intraductal papillary mucinous neoplasms the pancreaticoduodenectomy was extended to the body in 6 and totalized in 3 patients. Seven patients with adenocarcinoma involving the portomesenteric axis required venous resection and reconstruction. Conclusions. Early hind right approach is advocated in selected cases of pancreaticoduodenectomy to improve locoregional vascular control and determine, safely and early, whether there is mesopancreas involvement.

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Mesopancreas: A boundless structure, namely R1 risk in pancreaticoduodenectomy for pancreatic head carcinoma

Cited by 45 publications

References 37 publications

Superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic adenocarcinoma

Superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic adenocarcinoma

Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Hind Right Approach Pancreaticoduodenectomy: From Skill to Indications

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