Skip to main content

Advertisement

SpringerLink
Log in

Morphological speculation of the MHPD and related clinical projections

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Objective

The concept of mesopancreas has been brought into focus nowadays. Studies on membrane morphology of pancreas are clinically significant in determining an ideal surgical route for a “holy plane”. In this paper, we aimed to observe the structure of the peripancreatic membranes and its interactions with adjacent tissues; tentatively put forward the proposition of mesohepatopancreaticoduodenum (MHPD) and explore in depth in surgical local resection.

Methods

33 cadavers were examined in the experiment, including 30 for gross anatomy and 3 for histological observation after transection. The histological characteristics of the membrane covering the pancreas were proved by Masson and Bielschowsky silver staining and further explored in clinical application and testified in a surgical scenario. All above were carried out through traditional procedures.

Results

The anterior surface membrane of the pancreas was intact and the posterior portion expanding to the pancreaticoduodenum enclosed the surface of the duodenum and the pancreatic head, which could be easily isolated from the posterior abdominal wall. The posterior surface membrane around the body and tail wrapped the pancreatic parenchyma, which created a soft-tissue window for the posterior abdominal wall. Then, dense connective tissue adhesions were detected between the celiac artery and the superior mesenteric artery.

Conclusions

The embryonic origin of the mesopancreas and the surgical procedures were reviewed and inspected based on the proposition of MHPD and above results. We hope that this study could stir up our interest in the advancement of imaging diagnoses and minimally invasive surgical treatment of pancreas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Adham M, Singhirunnusom J (2012) Surgical technique and results of total mesopancreas excision (TMpE) in pancreatic tumors. Eur J SurgOncol 38:340–345. https://doi.org/10.1016/j.ejso.2011.12.015

    Article  CAS  Google Scholar 

  2. Agrawal MK, Thakur DS, Somashekar U, Chandrakar SK, Sharma D (2010) Mesopancreas: myth or reality? JOP 11:230–233

    PubMed  Google Scholar 

  3. Bouassida M, Mighri MM, Chtourou MF, Sassi S, Touinsi H, Hajji H, Sassi S (2013) Retroportal lamina or mesopancreas? Lessons learned by anatonfical and histological study of thirty three cadaveric dissections. Int J Surg 11:834–836. https://doi.org/10.1016/j.ijsu.2013.08.009

    Article  PubMed  Google Scholar 

  4. Chun-Yang MA, Xiao GQ, Zhu F, Peng F, Zhang H, Guo XJ, Gao HY, Wang HB, Ren YQ, Wang M (2016) The application and development of minimally invasive surgery in pancreatic surgery. Surgery (China) 1:22–28

    Google Scholar 

  5. Culligan K, Walsh S, Dunne C, Walsh M, Ryan S, Quondamatteo F, Dockery P, Coffey JC (2014) The mesocolon: a histological and electron microscopic characterization of the mesenteric attachment of the colon prior to and after surgical mobilization. Ann Surg 260:1048–1056. https://doi.org/10.1097/SLA.0000000000000323

    Article  PubMed  Google Scholar 

  6. Dou YR, Zheng N, Gong J, Tang W, Okoye CS, Zhang Y, Chen YX, Zhang Y, Pi SY, Qu LC, Yu SB, Sui HJ (2019) Existence and features of the myodural bridge in Gallus domesticus: indication of its important physiological function. AnatSciInt 94:184–191. https://doi.org/10.1007/s12565-018-00470-2

    Article  CAS  Google Scholar 

  7. Fu DL, Xu WY (2009) Lymph node metastasis characteristics and lymph node dissection in pancreatic cancer. J Surg Concepts Pract 14:488–492

    Google Scholar 

  8. Gaedcke J, Gunawan B, Grade M, Szöke R, Liersch T, Becker H, Ghadimi BM (2010) The mesopancreas is the primary site for RI resection in pancreatic head cancer: relevance for clinical trials. Langenbecks Arch Surg 395:451–458. https://doi.org/10.1007/s00423-009-0494-8

    Article  CAS  PubMed  Google Scholar 

  9. Gockel I, Domeyer M, Wolloscheck T, Konerding MA, Junginger T (2007) Resection of the mesopancreas (RMP): a new surgical classification of a known anatomical space. World J SurgOncol 5:44. https://doi.org/10.1186/1477-7819-5-44

    Article  Google Scholar 

  10. Gong JP (2015) Macro surgery: a merge of minimal invasion surgery, membrane anatomy, and industry. Chin J GastrointestSurg 18:745–746. https://doi.org/10.3760/cma.j.issn.1671-0274.2015.08.002

    Article  Google Scholar 

  11. Gong JP (2015) Surgical membrane anatomy-A New Basis of Surgery? Chin J Exp Sur 32:225–226. https://doi.org/10.3760/cma.j.issn.1001-9030.2015.02.003

    Article  Google Scholar 

  12. Heald RJ (1988) The “Holy Plane” of rectal surgery. J R Soc Med 81:503–508

    Article  CAS  Google Scholar 

  13. Huang JL, Li WG, Chen FZ, Su ZJ, Li FM, Liu B (2017) The clinical impact of artery-first approach combined with vascular resection and reconstruction in the treatment of pancreatic head carcinoma. Chin J Oncol 39:225–230. https://doi.org/10.3760/cma.j.issn.0253-3766.2017.03.014

    Article  CAS  Google Scholar 

  14. Hüscher CGS, Lirici MM (2017) Transanal total mesorectal excision: pneumodissection of retroperitoneal structures eases laparoscopic rectal resection. Dis Colon Rectum 60:1109–1112. https://doi.org/10.1097/DCR.0000000000000893

    Article  PubMed  Google Scholar 

  15. Inoue Y, Saiura A, Yoshioka R, Ono Y, Takahashi M, Arita J, Takahashi Y, Koga R (2015) Pancreatoduodenectomy with systematic mesopancreas dissection using a supracolic anterior artery-first approach. Ann Surg 262:1092–1101. https://doi.org/10.1097/SLA.0000000000001065

    Article  PubMed  Google Scholar 

  16. Ironside N, Barreto SG, Loveday B, Shrikhande SV, Windsor JA, Pandanaboyana S (2018) Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival. Br J Surg 105:628–636. https://doi.org/10.1002/bjs.10832

    Article  CAS  PubMed  Google Scholar 

  17. Kawabata Y, Tanaka T, Nishi T, Monma H, Yano S, Tajima Y (2012) Appraisal of a total mesopancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma. Eur J SurgOncol 38:574–579. https://doi.org/10.1016/j.ejso.2012.04.007

    Article  CAS  Google Scholar 

  18. Li AM, Chen JZ, Lv J, Liu X, Liu QD (2020) Modified pancreatojejunostomy in robotic pancreaticoduodenectomy for patients with high risk of postoperative pancreatic fistula. ClinSurg 5:2876

    Google Scholar 

  19. Negoi I, Hostiuc S, Runcanu A, Negoi RI, Beuran M (2017) Superior mesenteric artery first approach versus standard pancreaticoduodenectomy: a systematic review and meta-analysis. HepatobiliaryPancreat Dis Int 16:127–138. https://doi.org/10.1016/s1499-3872(16)60134-0

    Article  Google Scholar 

  20. Peparini N, Chirletti P (2012) Extended lymphadenectomy does not improve prognosis in pancreatic carcinoma: is that really so? J HepatobiliaryPancreatSci 19:297–298. https://doi.org/10.1007/s00534-011-0501-7

    Article  Google Scholar 

  21. Popescu I, Dumitrascu T (2011) Total mesopancreas excision: key point of resection in pancreatic head adenocarcinoma. Hepatogastroenterology 58:202–207. https://doi.org/10.1136/gut.2008.170811corr1

    Article  PubMed  Google Scholar 

  22. Ramia JM, De-la-Plaza R, Manuel-Vazquez A, Lopez-Marcano A, Morales R (2018) Systematic review of the mesopancreas: concept and clinical implications. ClinTranslOncol 20:1385–1391. https://doi.org/10.1007/s12094-018-1869-5

    Article  CAS  Google Scholar 

  23. Segura-Anaya E, Flores-Miranda R, Martínez-Gómez A, Dent MAR (2018) A novel histochemical method of simultaneous detection by a single- or double-immunofluorescence and Bielschowsky’s silver staining in teased rat sciatic nerves. J Neurosci Methods 304:46–51. https://doi.org/10.1016/j.jneumeth.2018.03.007

    Article  CAS  PubMed  Google Scholar 

  24. Sharma D, Isaji S (2016) Mesopancreas is a misnomer: Time to correct the nomenclature. J HepatobiliaryPancreatSci 23:745–749. https://doi.org/10.1002/jhbp.402

    Article  Google Scholar 

  25. Suzuki F, Fujiwara Y, Hamura R, Haruki K, Sakamoto T, Shiba H, Yanaga K (2019) Combination of Distance from Superior Mesenteric Artery and Serum CA19–9 as a Novel Prediction of local recurrence in patients with pancreatic cancer following resection. Anticancer Res 39:1469–1478 https://doi.org/https://doi.org/10.21873/anticanres.13264

  26. Terakawa H, Kitagawa H, Makino I, Hayashi H, Oyama K, Nakagawara H, Miyashita T, Tajima H, Takamura H, Fushida S, Ozaki N, Ohta T (2017) Location of the meso-pancreatoduodenum as a regional lymphatic basin for pancreatic head carcinoma. OncolLett 14:397–403. https://doi.org/10.3892/ol.2017.6138

    Article  Google Scholar 

  27. Xu JY, Chen YR, Liu C, Tian L, Wang JW, Cui D, Wang Y, Zhang WG, Yang YM (2017) Anatomic study and clinical practice of mesopancreas and total mesopancreatic excision. Chin J Surg 55:532–538. https://doi.org/10.3760/cma.j.issn.0529-5815.2017.07.011

    Article  CAS  PubMed  Google Scholar 

  28. Yi SQ, Nagakawa Y, Ren K, Dai YD, Zhang M, Chen JF, Wang ZD, Miwa Y, Liu T, Lu XM (2020) The mesopancreas and pancreatic head plexus: morphological, developmental, and clinical perspectives. SurgRadiolAnat 42(12):1501–1508. https://doi.org/10.1007/s00276-020-02547-y

    Article  Google Scholar 

  29. Zhou GW, Zhou ZQ (2014) The recognition to mesopancreasexcision:surgical anatomy concept of standardization of regional lymph node dissection. Chin J Surg 52:807–808. https://doi.org/10.3760/cma.j.issn.0529-5815.2014.11.003

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to express our gratitude by acknowledging donor cadavers and their families in this scientific article and research which are the ultimate scientific work thanks to the gift of the donors to anatomic sciences. We would further like to thank Yue Gao, Runjing Wang, Yungang Lai, Yue Xu, Wei Lv, Jungui Liu for their excellent technical assistance.

Funding

This research was supported by Capital Special Foundation for Clinical Application Research (Beijing, China. Grant number 2017YFC0110401).

Author information

Author notes

  1. Yue Gao and Runjing Wang contributed equally

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, General Rocket Hospital of Chinese People’s Liberation Army, Beijing, People’s Republic of China

    Yue Gao, Wei Lv, Jungui Liu & Weihong Duan

  2. Department of Human Anatomy, Dalian Medical University, Dalian, People’s Republic of China

    Runjing Wang, Yue Xu & Yuanshan Fu

  3. Department of Hepatobiliary Surgery, the First Hospital of Handan of Hebei Province, Handan, People’s Republic of China

    Yungang Lai

Authors
  1. Yue Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Runjing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yungang Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yue Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wei Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jungui Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuanshan Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Weihong Duan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuanshan Fu.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gao, Y., Wang, R., Lai, Y. et al. Morphological speculation of the MHPD and related clinical projections. Surg Radiol Anat 43, 1373–1384 (2021). https://doi.org/10.1007/s00276-021-02725-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-021-02725-6

Keywords

Search

Navigation