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 ...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. The specimen margins were measured in three dimensions, and 86 patients （71.6%） achieved R0 resection. Conclusions： TMpE is safe and feasible for pancreatic head cancer and is particularly helpful to increase the R0 resection rate.展开更多
Pancreatic head carcinoma(PHC)is one of the common gastrointestinal malignancies with a high morbidity and poor prognosis.At present,radical surgery is still the curative treatment for PHC.However,in clinical practice...Pancreatic head carcinoma(PHC)is one of the common gastrointestinal malignancies with a high morbidity and poor prognosis.At present,radical surgery is still the curative treatment for PHC.However,in clinical practice,the actual R0 resection rate,the local recurrence rate,and the prognosis of PHC are unsatisfactory.Therefore,the concept of total mesopancreas excision(TMpE)is proposed to achieve R0 resection.Although there have various controversies and discussions on the definition,the range of excision,and clinical prognosis of TMpE,the concept of TMpE can effectively increase the R0 resection rate,reduce the local recurrence rate,and improve the prognosis of PHC.Imaging is of importance in preoperative examination for PHC;however,traditional imaging assessment of PHC does not focus on mesopancreas.This review discusses the application of medical imaging in TMpE for PHC,to provide more accurate preoperative evaluation,range of excision,and more valuable postoperative follow-up evaluation for TMpE through imaging.It is believed that with further extensive research and exploratory application of TMpE for PHC,large-sample and multicenter studies will be realized,thus providing reliable evidence for imaging evaluation.展开更多
Preoperative imaging staging based on tumor,node,metastasis classification cannot be effective to avoid R1 resection because only further improvements in imaging technologies will allow the precise assessment of perin...Preoperative imaging staging based on tumor,node,metastasis classification cannot be effective to avoid R1 resection because only further improvements in imaging technologies will allow the precise assessment of perineural and lymphatic invasion and the occurrence of microscopic tumour deposits in the mesopancreas.However,waiting for further improvements in imaging technologies,total mesopancreas excision remains the only tool able to precisely assess mesopancreatic resection margin status,maximize the guarantee of radicality in cases of negative(R0)mesopancreatic resection margins,and stage the mesopancreas.展开更多
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 mesopancr...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 retropancreaticand 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 epithelialmesenchymal transition-related processes involved in tumor progression may impact on the prevalence of R1 resection or local recurrence rates after R0 surgery.These concepts imply that mesopancreas resection during PD for pancreatic head carcinoma should be extended to the paraaortic area in order to maximize retropancreatic clearance and minimize the likelihood of an R1 resection or the persistence of residual tumor cells after R0 resection.In PD for pancreatic head carcinoma,the rationale for dissection of the paraaortic area is to control the spread of the tumor cells along the mesopancreatic resection margin,rather than to control or stage the nodal spread.Although mesopancreatic resection cannot be considered"complete"or"en bloc",it should be"extended as far as possible"or be"maximal",including dissection of16a2 and 16b1 paraaortic areas.展开更多
The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy(PD);that is,en bloc resection using a non-touch isolation technique.We have been developing isolated PD for pancreatic cancer since 1981,w...The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy(PD);that is,en bloc resection using a non-touch isolation technique.We have been developing isolated PD for pancreatic cancer since 1981,when we developed an antithrombogenic bypass catheter for the portal vein.In this operation,the first and most important step is the use of a mesenteric approach instead of Kocher’s maneuver.The mesenteric approach allows dissection from the non-cancer infiltrating side and determination of cancer-free surgical margins and resectability,followed by systemic lymphadenectomy around the superior mesenteric artery.This approach enables early ligation of the inferior pancreatoduodenal artery and mesopancreas excision.The mesopancreas is the second portion of the pancreatic head nerve plexus.Isolated PD is the ideal surgery for pancreatic head cancer from both surgical and oncological viewpoints.In patients with resectable pancreatic head cancer,isolated PD using the mesenteric approach is suspected to have a higher survival rate than conventional PD using Kocher’s maneuver.The precise surgical techniques of the mesenteric approach are herein described.展开更多
基金Supported by Shanghai municipal hospital burgeoning and leading edge technology projects No.SHDC12014109
文摘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. The specimen margins were measured in three dimensions, and 86 patients （71.6%） achieved R0 resection. Conclusions： TMpE is safe and feasible for pancreatic head cancer and is particularly helpful to increase the R0 resection rate.
文摘Pancreatic head carcinoma(PHC)is one of the common gastrointestinal malignancies with a high morbidity and poor prognosis.At present,radical surgery is still the curative treatment for PHC.However,in clinical practice,the actual R0 resection rate,the local recurrence rate,and the prognosis of PHC are unsatisfactory.Therefore,the concept of total mesopancreas excision(TMpE)is proposed to achieve R0 resection.Although there have various controversies and discussions on the definition,the range of excision,and clinical prognosis of TMpE,the concept of TMpE can effectively increase the R0 resection rate,reduce the local recurrence rate,and improve the prognosis of PHC.Imaging is of importance in preoperative examination for PHC;however,traditional imaging assessment of PHC does not focus on mesopancreas.This review discusses the application of medical imaging in TMpE for PHC,to provide more accurate preoperative evaluation,range of excision,and more valuable postoperative follow-up evaluation for TMpE through imaging.It is believed that with further extensive research and exploratory application of TMpE for PHC,large-sample and multicenter studies will be realized,thus providing reliable evidence for imaging evaluation.
文摘Preoperative imaging staging based on tumor,node,metastasis classification cannot be effective to avoid R1 resection because only further improvements in imaging technologies will allow the precise assessment of perineural and lymphatic invasion and the occurrence of microscopic tumour deposits in the mesopancreas.However,waiting for further improvements in imaging technologies,total mesopancreas excision remains the only tool able to precisely assess mesopancreatic resection margin status,maximize the guarantee of radicality in cases of negative(R0)mesopancreatic resection margins,and stage the mesopancreas.
文摘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 retropancreaticand 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 epithelialmesenchymal transition-related processes involved in tumor progression may impact on the prevalence of R1 resection or local recurrence rates after R0 surgery.These concepts imply that mesopancreas resection during PD for pancreatic head carcinoma should be extended to the paraaortic area in order to maximize retropancreatic clearance and minimize the likelihood of an R1 resection or the persistence of residual tumor cells after R0 resection.In PD for pancreatic head carcinoma,the rationale for dissection of the paraaortic area is to control the spread of the tumor cells along the mesopancreatic resection margin,rather than to control or stage the nodal spread.Although mesopancreatic resection cannot be considered"complete"or"en bloc",it should be"extended as far as possible"or be"maximal",including dissection of16a2 and 16b1 paraaortic areas.
文摘The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy(PD);that is,en bloc resection using a non-touch isolation technique.We have been developing isolated PD for pancreatic cancer since 1981,when we developed an antithrombogenic bypass catheter for the portal vein.In this operation,the first and most important step is the use of a mesenteric approach instead of Kocher’s maneuver.The mesenteric approach allows dissection from the non-cancer infiltrating side and determination of cancer-free surgical margins and resectability,followed by systemic lymphadenectomy around the superior mesenteric artery.This approach enables early ligation of the inferior pancreatoduodenal artery and mesopancreas excision.The mesopancreas is the second portion of the pancreatic head nerve plexus.Isolated PD is the ideal surgery for pancreatic head cancer from both surgical and oncological viewpoints.In patients with resectable pancreatic head cancer,isolated PD using the mesenteric approach is suspected to have a higher survival rate than conventional PD using Kocher’s maneuver.The precise surgical techniques of the mesenteric approach are herein described.
