J Cancer 2017; 8(17):3575-3584. doi:10.7150/jca.21341

Research Paper

Total mesopancreas excision for the treatment of pancreatic head cancer

Jingyong Xu1,2*, Xiaodong Tian1*, Yiran Chen1, Yongsu Ma1, Chang Liu1, Long Tian3, Jianwei Wang3, Jianqiang Dong4, Di Cui5, Yang Wang6, Weiguang Zhang3✉, Yinmo Yang1✉

1. Department of General Surgery, Peking University First Hospital, 100034, Beijing, China;
2. Department of General Surgery, Beijing Hospital, National Centre of Gerontology, China, 100730, Beijing, China;
3. Department of Human Anatomy, Health Science Centre, Peking University, 100191, China;
4. Department of Pathology, Peking University People's Hospital, Beijing, 100044, China;
5. Department of Pathology, Beijing Hospital, National Center of Gerontology, China Beijing, 100730, China;
6. Medical research and Biometrics Center, Fuwai Hospital, Peking Union Medical College, Beijing, 100730, China.
*Jingyong Xu and Xiaodong Tian contributed equally to this work.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license (https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Xu J, Tian X, Chen Y, Ma Y, Liu C, Tian L, Wang J, Dong J, Cui D, Wang Y, Zhang W, Yang Y. Total mesopancreas excision for the treatment of pancreatic head cancer. J Cancer 2017; 8(17):3575-3584. doi:10.7150/jca.21341. Available from http://www.jcancer.org/v08p3575.htm

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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.

Keywords: Total mesopancreas excision, Pancreatic head cancer, Resection, Mesopancreas