International consensus on mesopancreas and total mesopancreas excision (MESODELPHI)
Luís Felipe Leite1, Marcos Belotto2, Marcelo Sá de Araújo1
1Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
Background:
The absence of a standardized anatomical definition of the mesopancreas has precluded meaningful comparison across studies on total mesopancreas excision (TMpE). The MESODELPHI consensus aimed to establish international agreement on its definition, surgical boundaries, and clinical role in pancreatic cancer management.
Methods:
An international modified Delphi process, informed by a prior systematic review, included 43 pancreatic surgery experts from 20 countries across two rounds. Statements were rated on a 5-point Likert scale, with consensus predefined as ≥80% agreement.
Results:
Consensus was achieved for 19 of 27 statements in Round 1. All participants (100%) agreed the mesopancreas is a retropancreatic compartment of lymphatic, neurovascular, and adipose tissue, with 97.7% agreeing on its anatomical boundaries. Both artery-first and mesenteric-first approaches were considered feasible surgical strategies (97.7%). Most experts (81.4%) favored TMpE over conventional pancreatoduodenectomy for curative-intent surgery. There was strong agreement that further investigation into the impact of TMpE on survival outcomes is necessary (97.7%), and that education on mesopancreas anatomy should be integrated into surgical training programs (93.0%).
Conclusions:
This consensus provides the first standardized definition of the mesopancreas, recommends "mesopancreas" as the unifying term over alternative nomenclature, and offers an international framework to guide future research and surgical practice.
Insights
The MESODELPHI consensus established a standardized definition for the mesopancreas, crucial for comparing total mesopancreas excision (TMpE) studies in pancreatic cancer management.
Area of Science:
- Surgical Oncology
- Anatomy
- Gastroenterology
Background:
- Lack of a standardized definition for the mesopancreas hindered comparative research on total mesopancreas excision (TMpE).
- The MESODELPHI consensus aimed to create international agreement on mesopancreas definition, boundaries, and role in pancreatic cancer surgery.
Purpose of the Study:
- To establish a standardized anatomical definition of the mesopancreas.
- To achieve international consensus on the surgical boundaries and clinical significance of the mesopancreas in pancreatic cancer management.
Main Methods:
- An international modified Delphi process involving 43 experts from 20 countries.
- Statements were rated on a 5-point Likert scale, with consensus defined as ≥80% agreement.
Main Results:
- Consensus reached on 19 of 27 statements, including a definition of the mesopancreas as a retropancreatic compartment (100% agreement).
- High agreement on anatomical boundaries (97.7%), feasibility of artery-first and mesenteric-first approaches (97.7%), and preference for TMpE over conventional pancreatoduodenectomy (81.4%).
- Strong agreement on the need for further research into TMpE's survival impact (97.7%) and integration of mesopancreas anatomy into surgical training (93.0%).
Conclusions:
- The first standardized definition of the mesopancreas was established.
- "Mesopancreas" is recommended as the unifying term.
- An international framework is provided to guide future research and surgical practice in pancreatic cancer treatment.