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Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction
Published on: January 3, 2020
What do surgeons need to know about the mesopancreas
Eduardo de Souza M Fernandes1,2, Oliver Strobel3,4, Camila Girão1,2
1Department of Surgery, Adventista Silvestre Hospital, Rio de Janeiro, RJ, Brazil.
Background:
Pancreatoduodenectomy is the only treatment with a promise of cure for patients with pancreatic head adenocarcinoma, and a negative resection margin is an important factor related to overall survival. Complete clearance of the medial margin with removal of the so-called mesopancreas may decrease the recurrence rate after pancreatic resection. Here, we present some important information about the mesopancreas, total mesopancreas excision, and technical aspects to achieve negative resection margins. The area named mesopancreas is defined as the tissue located between the head of the pancreas and the superior mesenteric vessels and the celiac axis and consists of the nerve plexus, lymphatic tissue, and connective tissue. The superior mesenteric and celiac arteries define the border of the mesopancreas. En bloc resection of anterior and posterior pancreatoduodenal nodes, hepatoduodenal nodes, along the superior mesenteric artery nodes, pyloric nodes, and nodes along the common hepatic artery is necessary.
Conclusions:
Improved knowledge of the surgical anatomy of the region and technical refinements of excision of the mesopancreas along with standardized pathological examination are important to increase and to determine radical resection of pancreatic head cancer.
Insights
Complete mesopancreas excision during pancreatoduodenectomy improves outcomes for pancreatic head cancer by ensuring negative resection margins. This technique is crucial for reducing recurrence and enhancing patient survival.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Surgical Anatomy
Background:
- Pancreatoduodenectomy offers the only potential cure for pancreatic head adenocarcinoma.
- Achieving negative resection margins, particularly the medial margin, is vital for patient survival.
- The mesopancreas, a region of connective tissue, nerves, and lymphatics, is key to complete tumor removal.
Purpose of the Study:
- To provide essential information on the mesopancreas and its complete excision.
- To detail technical aspects for achieving negative resection margins during pancreatic surgery.
- To highlight the importance of mesopancreas removal in reducing cancer recurrence.
Main Methods:
- Detailed description of the anatomical boundaries of the mesopancreas.
- Explanation of the en bloc resection technique for regional lymph nodes.
- Emphasis on the surgical dissection planes around the superior mesenteric and celiac axes.
Main Results:
- Complete clearance of the medial margin via mesopancreas excision can decrease recurrence rates.
- Understanding the surgical anatomy is critical for successful radical resection.
- Standardized pathological examination is necessary to confirm complete tumor removal.
Conclusions:
- Enhanced knowledge of surgical anatomy and refined total mesopancreas excision techniques are crucial.
- Standardized pathological assessment is important for determining radical resection.
- These advancements aim to improve outcomes for pancreatic head cancer patients.
