Related Experiment Video
Updated: Dec 23, 2025
Application of Mid-Pancreatectomy with End-to-End Anastomosis in Pancreatic Benign Tumors
Published on: February 9, 2024
Total mesopancreas excision for periampullary malignancy: a single-center propensity score-matched comparison of
Giuseppe Quero1,2,3, Claudio Fiorillo4,5, Roberta Menghi1,2
1Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Purpose:
Few comparative studies are available on the long-term prognostic role of mesopancreas (MP) excision after pancreaticoduodenectomy (PD). We compared the long-term outcomes of patients undergoing standard PD (sPD) and PD with MP excision (PD-MPe).
Methods:
Sixty sPDs were compared to 60 matched PD-MPe patients for intraoperative and postoperative data, histopathological findings, and long-term outcomes.
Results:
R0 rate was similar in the two groups (p = 0.17). However, PD-MPe related to a lower rate of MP resection margin positivity (16.7% vs 5%; p = 0.04) and to a higher harvested lymph nodes number (19.8 ± 7.6 vs 10.1 ± 5.1; p < 0.0001). Local tumor recurrence was more frequent in the sPD cohort (55.5% vs 26.8% in the PD-MPe group; p = 0.002), with a consequent worse disease-free survival (DFS) (14.8% vs 22.3%; p = 0.04). An inferior 5-year overall survival (OS) was noted in case of MP margin positivity compared with MP margin negativity (0% vs 29%; p < 0.0001). MP positivity resulted as an independent prognostic factor for both a worse OS and DFS at the multivariate analysis.
Conclusion:
PD-MPe offers clinical advantages in terms of MP resection margin status, local recurrence, long-term mortality, and DFS. The lower MP positivity rate, achieved with PD-MPe, leads to better outcomes both in terms of OS and DFS.
Insights
Mesopancreas (MP) excision during pancreaticoduodenectomy (PD) improves long-term outcomes by reducing local recurrence and improving survival. This surgical approach is associated with better disease-free survival (DFS) and overall survival (OS).
Area of Science:
- Surgical Oncology
- Gastroenterology
- Oncology
Background:
- Pancreaticoduodenectomy (PD) is a standard procedure for pancreatic head tumors.
- The prognostic significance of mesopancreas (MP) involvement remains under investigation.
- Limited comparative data exist on the long-term impact of MP excision during PD.
Purpose of the Study:
- To compare the long-term outcomes of standard PD (sPD) versus PD with MP excision (PD-MPe).
- To evaluate the prognostic role of mesopancreas status in patients undergoing PD.
Main Methods:
- A retrospective comparison of 60 sPD patients and 60 matched PD-MPe patients.
- Data analyzed included intraoperative and postoperative parameters, histopathological findings, and long-term survival outcomes.
- Multivariate analysis was performed to identify independent prognostic factors.
Main Results:
- PD-MPe demonstrated a significantly lower rate of MP resection margin positivity (5% vs. 16.7%, p=0.04).
- Local tumor recurrence was significantly lower in the PD-MPe group (26.8% vs. 55.5%, p=0.002), leading to improved disease-free survival (DFS).
- MP margin positivity was an independent negative prognostic factor for both overall survival (OS) and DFS.
Conclusions:
- PD-MPe offers significant clinical advantages over sPD, including improved MP resection margin status and reduced local recurrence.
- The enhanced margin status achieved with PD-MPe translates to better long-term DFS and OS.
- Mesopancreas excision should be considered in PD to improve patient outcomes.
