M Adham1, J Singhirunnusorn. 1. Department of Hepato-biliary and Pancreatic Surgery, Edouard Herriot Hospital, HCL, Lyon, France. mustapha.adham@chu-lyon.fr
Abstract
BACKGROUND AND OBJECTIVES: Retro pancreatic invasion is a major concern in pancreatic head carcinoma. Posterior clearance has been recognized as an independent risk factor for disease recurrence and hence patient survival. The aim of this study was to report a standardized method that ensures posterior clearance with Total Mesopancreas Excision (TMpE). METHODS: Our procedure consisted in a posterior approach with cranio-caudal dissection at the origin of the superior mesenteric artery and the celiac trunk all along their right semi-circumference. This allowed a complete clearance of retro pancreatic tissues with safe control of pancreaticoduodenal arteries at their origin. RESULTS: Fifty-two consecutive pancreatic resections with TMpE were performed. Sixteen cases were associated to vascular resection. Pathology revealed an adenocarcinoma of the pancreatic duct, distal bile duct, periampullary and neuroendocrine carcinoma. Mesopancreas was invaded by cancer in 12 cases, of these, 3 had invaded margins and 7 had a margin less than 1 mm. Mesopancreas was the only site of tumour infiltration. Applying the International Union Against Cancer criteria, an R0 resection was thus achieved in 42 patients. CONCLUSION: Our procedure is feasible and safe in experienced hand. It is a description of a standardized method for TMpE that clearly shows an advantage in improving posterior clearance and R0 resection.
BACKGROUND AND OBJECTIVES: Retro pancreatic invasion is a major concern in pancreatic head carcinoma. Posterior clearance has been recognized as an independent risk factor for disease recurrence and hence patient survival. The aim of this study was to report a standardized method that ensures posterior clearance with Total Mesopancreas Excision (TMpE). METHODS: Our procedure consisted in a posterior approach with cranio-caudal dissection at the origin of the superior mesenteric artery and the celiac trunk all along their right semi-circumference. This allowed a complete clearance of retro pancreatic tissues with safe control of pancreaticoduodenal arteries at their origin. RESULTS: Fifty-two consecutive pancreatic resections with TMpE were performed. Sixteen cases were associated to vascular resection. Pathology revealed an adenocarcinoma of the pancreatic duct, distal bile duct, periampullary and neuroendocrine carcinoma. Mesopancreas was invaded by cancer in 12 cases, of these, 3 had invaded margins and 7 had a margin less than 1 mm. Mesopancreas was the only site of tumour infiltration. Applying the International Union Against Cancer criteria, an R0 resection was thus achieved in 42 patients. CONCLUSION: Our procedure is feasible and safe in experienced hand. It is a description of a standardized method for TMpE that clearly shows an advantage in improving posterior clearance and R0 resection.
Authors: J Perinel; G Nappo; M El Bechwaty; T Walter; V Hervieu; P J Valette; P Feugier; M Adham Journal: Langenbecks Arch Surg Date: 2016-07-30 Impact factor: 3.445