Impact of Total Mesopancreas Excision on the Superior Mesenteric Artery Margin Status

Abstract

Introduction: Pancreatic ductal head adenocarcinoma (PDHAC) is a lethal disease with poor prognosis and surgical resection with complete microscopic resection (R0) in association with multimodal treatment currently represents the only curative strategy. The dissected margins around the superior mesenteric artery (SMA) are reported to be the most favorable R1 site for PDHAC. Therefore, modifications have been made to the classic surgical technique (Whipple) to improve the rate of R1 resections, such as the total mesopancreas excision (TMpE). The purpose of this study was to evaluate the impact of TMpE on the SMA margin status. Methods: This study included 93 patients with PDHAC who were treated in the Hepatobiliary Surgery Department of Miguel Servet University Hospital in Saragossa, Spain, during a 7-years period (2010-2017). They were divided into two groups. Group A included patients who underwent pancreaticoduodenectomy (PD) with TMpE and group B included standar PD (S-PD). The collected data were prospectively collected and statistically analyzed by SPSS 19.0 statistical software package. Results: The R0 resection rate was 52.1% (25/48) in Group A and 31.1% (14/45) in Group B. There was significant difference in the R0 resection rate between the two groups (p=0.027). The R1 SMA resection margin rate was 18. Conclusions: TMpE improves the oncological results of PD for pancreatic head adenocarcinoma as it halves the rate of R1 resections at the SMA resection margin.