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Wioletta Masiak-Segit, Karol Rawicz-Pruszyński, Magdalena Skórzewska, Wojciech P Polkowski
The only way to cure the patient with adenocarcinoma of the pancreas (RT) is surgical excision of the tumor. The standard surgical treatment of resectable pancreatic carcinoma is considered the classic pancreatoduodenectomy (PD) with the Kausch- Whipple procedure, or the pylorus-preserving PD with the Traverso-Longmire method. The most difficult technically and at the same time the most important PD stage from an oncological point of view is the separation of the head of the pancreas from the superior mesenteric artery...
April 30, 2018: Polski Przeglad Chirurgiczny
J M Ramia, R De-la-Plaza, A Manuel-Vazquez, A Lopez-Marcano, R Morales
BACKGROUND: In 2007, Gockel et al. coined the term mesopancreas (MP). In the next 10 years, a limited number of publications about MP have been published, but little is known about the oncological benefit of MP resection. We performed a systematic review of the literature on MP. METHODS: An electronic search was performed in PubMed, EMBASE, Cochrane, Latindex, Scielo, and Koreamed databases until 15 June 2017 to identify all published articles dealing with the subject of MP...
April 19, 2018: Clinical & Translational Oncology
Ionut Negoi, Mircea Beuran, Sorin Hostiuc, Ruxandra Irina Negoi, Yosuke Inoue
BACKGROUND AND PURPOSE: Mesopancreas dissection with central vascular ligation and the superior mesenteric artery (SMA)-first approach represent the cornerstone of current principles for radical resection for pancreatic head cancer. The surgeon dissecting around the SMV and SMA should be aware regarding the anatomical variants in this area. The aims of this systematic review and meta-analysis are to detail the surgical anatomy of the superior mesenteric vessels and to propose a standardized terminology with impact in pancreatic cancer surgery...
January 23, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Jingyong Xu, Xiaodong Tian, Yiran Chen, Yongsu Ma, Chang Liu, Long Tian, Jianwei Wang, Jianqiang Dong, Di Cui, Yang Wang, Weiguang Zhang, Yinmo Yang
Mesopancreas is a controversial structure. This study aimed to explore the anatomical characteristics of the mesopancreas, define the range of the total mesopancreas excision (TMpE), and evaluate the feasibility, safety and effectivity of TMpE in the treatment of pancreatic head cancer. The clinical and pathological data of 58 consecutive patients undergoing TMpE for pancreatic head carcinoma from January 2013 to December 2015 were analyzed prospectively. The perioperative morbidity, mortality and clinical outcomes of patients undergoing TMpE were compared with the patients undergoing conventional pancreaticoduodenectomy...
2017: Journal of Cancer
J Y Xu, Y R Chen, C Liu, L Tian, J W Wang, D Cui, Y Wang, W G Zhang, Y M Yang
Objective: To explore the anatomical characteristics of the mesopancreas, to define the range of the total mesopancreas excision and to evaluate the feasibility, safety and effectiveness in the treatment of pancreatic cancer. Methods: A regional anatomical and pathological study was performed on 14 cadavers with large slices and paraffin sections. The clinical and pathological data of 58 consecutive patients underwent total mesopancreas excision for pancreatic head carcinoma from January 2013 to December 2015 were prospectively collected and analysed...
July 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Z D Wang, X M Jiang, X Y Zhong, P C Kang, C L Li, Z L Su, S Tai, C X Hua, Y F Cui
Objective: To investigate the clinical application of combined multiple artery-first approach to pancreatoduodenectomy. Methods: The clinical data of 53 patients who were diagnosed with peripancreatic head tumor at Department of Biliary-Pancreatic Surgery of Second Affiliated Hospital of Harbin Medical University between June 2013 and June 2015 was retrospectively analyzed.Pancreatic enhanced CT scan, magnetic resonance cholangiopancreatography, ultrasonography and tumor marker detection were applied for all the patients preoperatively...
November 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Dhananjaya Sharma, Shuji Isaji
Focused pathological attention to tumor invasion of the retroperitoneal resection margin after pancreaticoduodenectomy for cancer of head of the pancreas led to the knowledge of strong tendency of cancer cells to infiltrate into the retropancreatic tissue and to spread along the peripancreatic neural plexuses as the cause of local recurrence. The term 'mesopancreas' was coined to describe perineural lymphatic layer located dorsally to the pancreas and it was suggested that its complete resection will minimize loco-regional recurrence and improve outcome...
December 2016: Journal of Hepato-biliary-pancreatic Sciences
Wenguang Wu, Xu'an Wang, Xiangsong Wu, Maolan Li, Hao Weng, Yang Cao, Ruifa Bao, Sijun Su, Jianhua Lu, Wei Gong, Weibin Shi, Jun Gu, Xuefeng Wang, Yingbin Liu, Zhiwei Quan, Shuyou Peng
OBJECTIVE: To evaluate the feasibility and safety of total mesopancreas excision (TMpE) in the treatment of pancreatic head cancer. METHODS: The clinical and pathological data of 120 patients with pancreatic head cancer who had undergone TMpE in our center from May 2010 to January 2014 were retrospectively analyzed. RESULTS: The mean operative time was (275.0±50.2) min and the average intra-operative blood loss was (390.0±160.5) mL. Post-operative complications were reported in 45 patients, while no peri-operative death was noted...
August 2016: Chinese Journal of Cancer Research, Chung-kuo Yen Cheng Yen Chiu
Gennaro Nappo, Julie Perinel, Michel El Bechwaty, Mustapha Adham
Pancreaticoduodenectomy (PD) represents an important challenge for surgeons due to the complexity of the operation, requirement for technical skills and experience, and postoperative management involving important and life-threatening complications. Despite efforts to reduce mortality in high-volume centers, the morbidity rate is still high (approximately 40-50%). The PD standardization process of surgical aspects and preoperative and postoperative settings is essential to permit pancreatic surgeons to communicate in the same language, compare experiences and results, and to improve the short- and long-term outcomes...
April 2016: Pancreas
Thilo Welsch, Ulrich Bork, Marius Distler, Jürgen Weitz
Complete surgical resection with microscopically tumor-free resection margins (R0) is the most important survival determinant for patients with localized pancreatic cancer. The medial and posterior resection margins are the dominant sites of microscopic tumor involvement, and outline the so-called mesopancreas. In this study, we present a modified surgical approach to the superior mesenteric artery, celiac trunc, and mesopancreas during pancreatoduodenectomy, which enables a comfortable exposure and radical en bloc clearance of the mesopancreas and the tissue adjacent to the superior mesenteric artery...
May 2016: Journal of Surgical Oncology
Masanori Sugiyama, Yutaka Suzuki, Tetsuya Nakazato, Masaaki Yokoyama, Masaharu Kogure, Nobutsugu Abe, Tadahiko Masaki, Toshiyuki Mori
BACKGROUND: In pancreatoduodenectomy (PD), mesopancreas excision with division of the inferior pancreatoduodenal artery (IPDA) is technically difficult because of the complex anatomy resulting from intestinal rotation occurring during embryological development. We have developed an intestinal derotation procedure for facilitating mesopancreas excision. The perioperative factors of PD were retrospectively compared between our derotation and the conventional procedure. METHODS: The entire small intestine and right colon are mobilized from the retroperitoneum, and intestinal rotation is reduced...
May 2016: Surgery
Nadia Peparini, Roberto Caronna, Piero Chirletti
A correspondence between the "meso" of the rectum and of the pancreas has recently been reported. Here we highlight the differences between mesorectum and mesopancreas. Based on anatomical findings from a series of 89 consecutive pancreaticoduodenectomies and 71 consecutive total mesorectal excisions, we observed that in contrast to the mesorectum, the mesopancreas did not have well-defined anatomic boundaries and was continuous and connected through its components with the para-aortic area. In rectal cancer, tumor deposits and nodal involvement could be confined to the mesorectum (i...
October 2015: Hepatobiliary & Pancreatic Diseases International: HBPD INT
Zhe Cao, Jianwei Xu, Qianqian Shao, Taiping Zhang, Yupei Zhao
As we have a deeper and more thorough understanding of the biological behavior of pancreatic head cancer, surgical treatment concepts of this lethal disease are changing all the time. Meanwhile, numerous arguments emerge. Thus, we will probe into the focuses and arguments in the surgical treatment of pancreatic head cancer in this article, including the scope of lymphadenectomy, total mesopancreas excision (TMpE), vascular resection, minimally invasive pancreaticoduodenectomy (PD), palliative resection, surgery for recurrent disease and surgery for primary pancreatic cancer and liver metastasis...
August 2015: Chinese Journal of Cancer Research, Chung-kuo Yen Cheng Yen Chiu
Ramachandra Chowdappa, Vasu Reddy Challa
Pancreatic cancer is associated with poor prognosis and surgery remains the main modality of treatment. Negative resection margin is an important prognostic factor for survival. Retropancreatic margin or the medial margin is the most common site of positive resection margin. Mesopancreas was proposed in analogy with mesorectum, which is considered as a fusion fascia formed embryologically during the development of pancreas. This mesopancreas lies posterior to the pancreas and contains pancreaticoduodenal vessels, lymphatics, nerve plexus and loose areolar tissue...
March 2015: Indian Journal of Surgical Oncology
Nadia Peparini
This review highlights the rationale for dissection of the 16a2 and 16b1 paraaortic area during pancreaticoduodenectomy (PD) for carcinoma of the head of the pancreas. Recent advances in surgical anatomy of the mesopancreas indicate that the retropancreatic area is not a single entity with well defined boundaries but an anatomical site of embryological fusion of peritoneal layers, and that continuity exists between the neuro lymphovascular adipose tissues of the retropancreatic and paraaortic areas. Recent advances in surgical pathology and oncology indicate that, in pancreatic head carcinoma, the mesopancreatic resection margin is the primary site for R1 resection, and that epithelial-mesenchymal transition-related processes involved in tumor progression may impact on the prevalence of R1 resection or local recurrence rates after R0 surgery...
March 14, 2015: World Journal of Gastroenterology: WJG
Guangwen Zhou, Zunqiang Zhou
No abstract text is available yet for this article.
November 2014: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Yosuke Inoue, Akio Saiura, Ryuji Yoshioka, Yoshihiro Ono, Michiro Takahashi, Junichi Arita, Yu Takahashi, Rintaro Koga
OBJECTIVE: To describe the details of the surgical technique of pancreatoduodenectomy (PD) with systematic mesopancreas dissection (SMD-PD), using a supracolic anterior artery-first approach. BACKGROUND: An artery-first approach in PD has been advocated in pancreatic cancer to judge resectability, clear the superior mesenteric artery margin from invasion, or reduce blood loss. However, the efficacy of an artery-first approach in mesopancreas dissection remains unclear...
December 2015: Annals of Surgery
Yinmo Yang
No abstract text is available yet for this article.
September 2014: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Stefan Georgescu, Corina Ursulescu, Valentin Titus Grigorean, Cristian Lupascu
Background. Pancreaticoduodenectomy is the potentially curative treatment for malignant and several benign conditions of the pancreatic head and periampullary region. While performing pancreaticoduodenectomy, early neck division may be impossible or inadequate in case of hepatic artery anatomic variants, suspected involvement of the superior mesenteric vessels, intraductal papillary mucinous neoplasm, and pancreatic head bleeding pseudoaneurysm. Our work aims to highlight a particular hind right approach pancreaticoduodenectomy in selected indications and assess the preliminary results...
2014: Gastroenterology Research and Practice
Chengfeng Wang
No abstract text is available yet for this article.
May 13, 2014: Zhonghua Yi Xue za Zhi [Chinese medical journal]
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