Treatment of Advanced Pancreatic Body and Tail Cancer by En Bloc Distal Pancreatectomy with Transverse Mesocolon Resection Using a Mesenteric Approach

Abstract

BackgroundPancreatic body and tail cancer easily invades the retroperitoneal tissue, including the transverse mesocolon. It is difficult to ensure a dissected peripancreatic margin using standard distal pancreatectomy for advanced pancreatic body and tail cancer.Thus, we developed a novel surgical procedure to ensure dissection of the peripancreatic margin. This involved performing dissection deeper than the fusion fascia of Toldt and further extensive en bloc resection of the root of the transverse mesocolon. We performed distal pancreatectomy with transverse mesocolon resection (DP-TCR) using the mesenteric approach and achieved good outcomes. MethodsThere are two main considerations regarding the surgical procedure using the mesenteric approach: 1) dissection deeper than the fusion fascia of Toldt (securing the vertical margin) and 2) modular resection of the pancreatic body and tail, with the root of the transverse mesocolon and adjacent organs in a horizontal direction (ensuring the caudal margin).