Pancreaticoduodenectomy with Total Mesopancreas Excision for Pancreatic Head Cancer. Impact on Postoperative Tumor Recurrence

Abstract

Introduction: Pancreatic ductal head adenocarcinoma (PDHAC) is a lethal disease. Although pancreaticoduodenectomy (PD) in association with multimodal treatment currently represents the only curative strategy, the prognosis for the PDHAC remains poor, local recurrence rate is very high due to the incomplete removal at the site of resection. The purpose of this study was to evaluate the impact of the total mesopancreas excision (TMpE) on the local and systemic recurrence rate and on the disease free survival at 12, 36 and 60 months. 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-year period (2010-2017) . They were divided into two groups. Group A included patients who underwent 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: There was no significant difference at months 12 and 60 post operation in the recurrence rate between the two groups depending on resection margins status (p>0.05); however, there was a significant difference at month 36 postoperation between them (p<0.05), the recurrence rate of tumor improves in Group A. There was significant difference at 12, 36 and 60 months postoperation in the disease free survival between the two groups. Conclusions: TMpE improves the disease free survival at 1, 3 and 5-years.