Total Mesopancreas excision in pancreaticoduodenectomy and its prognostic surgical outcomes in cancer head pancreas

Background: Pancreatic ductal adenocarcinoma has one of the worst survival rates, even after surgical resection, five-year survival rates only reach 20%. Many factors contribute to this poor outcome including resection margins, lympho-vascular & perineural invasion, tumor size, tumor type, tumor differentiation and nodal metastasis.Excision of the entire mesopancreas can result in complete clearance of retroperitoneal tissue and improve the prognosis of patients with pancreatic head cancer. It is mandatory to excise total meso-pancreas during the surgery for pancreatic head adenocarcinoma which may increase R0 resections and increase lymph node clearance. The aim of the study: Is to evaluate total mesopancreas excision in pancreaticoduodenectomy and its effect on surgical prognosis in cancer head pancreas. Patients and Methods: This is a prospective study including forty patients that has pancreatic head adenocarcinoma planned for pancreaticoduodenectomy.Patients included in the study had resectable adenocarcinoma located in head/neck/uncinate process of the pancreas. We excluded metastatic adenocarcinoma of head/neck/uncinate process of pancreas and locally advanced pancreatic carcinoma with vascular invasion. Results: Recurrence occurred in 14(35%) of patients during follow up, this result had a statistically significant relationship with resection margin status R1 (P<0.001). Positive meso-pancreatic margin involvement was held accountable for 12(30%) of the recurrent cases either alone or concomitant with other margins. The overall 1-year DFS rate was 56.1% of patients with mean of 9.962 months. DFS was significantly better in free meso-pancreatic margin patients (R0 MP) compared to positive meso-pancreatic margin patients (R1 MP) (11.502 Vs 7.083 months, p<0.001).Evaluation of the relationship between meso-pancreatic margin status and the presence of either LVI or PNI was statistically insignificant.Conclusions: Total meso-pancreas excision during pancreaticoduodenectomy is mandatory to achieve R0 at meso-pancreatic margin aiming to reduce recurrence and improve disease free survival.