Total meso-pancreas excision: key point of resection in pancreatic head adenocarcinoma

Pancreatic head cancer is a disease with a dismal prognosis, even after curative intent surgery, Resection represents the only hope for long-term survival. The negative resection margins (R0 resection) represent a strong independent prognostic factor. Up to 80% of so-called curative resections are, in fact, non-curative (with microscopically positive margins). The area most involved in positive resection margins is the meso-pancreas. Thus, the local recurrence is up to 80% within one year after resection. The term meso-pancreas was recently proposed to emphasize this area's role in positive resection margins, local recurrence after pancreatoduodenectomy and prognosis. Total meso-pancreas excision is presumed to decrease the rate of R1 resection and improve survival and is facilitated by a posterior/artery first approach.