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Total mesopancreas excision for periampullary malignancy: a single-center propensity score-matched comparison of long-term outcomes

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Abstract

Purpose

Few comparative studies are available on the long-term prognostic role of mesopancreas (MP) excision after pancreaticoduodenectomy (PD). We compared the long-term outcomes of patients undergoing standard PD (sPD) and PD with MP excision (PD-MPe).

Methods

Sixty sPDs were compared to 60 matched PD-MPe patients for intraoperative and postoperative data, histopathological findings, and long-term outcomes.

Results

R0 rate was similar in the two groups (p = 0.17). However, PD-MPe related to a lower rate of MP resection margin positivity (16.7% vs 5%; p = 0.04) and to a higher harvested lymph nodes number (19.8 ± 7.6 vs 10.1 ± 5.1; p < 0.0001). Local tumor recurrence was more frequent in the sPD cohort (55.5% vs 26.8% in the PD-MPe group; p = 0.002), with a consequent worse disease-free survival (DFS) (14.8% vs 22.3%; p = 0.04). An inferior 5-year overall survival (OS) was noted in case of MP margin positivity compared with MP margin negativity (0% vs 29%; p < 0.0001). MP positivity resulted as an independent prognostic factor for both a worse OS and DFS at the multivariate analysis.

Conclusion

PD-MPe offers clinical advantages in terms of MP resection margin status, local recurrence, long-term mortality, and DFS. The lower MP positivity rate, achieved with PD-MPe, leads to better outcomes both in terms of OS and DFS.

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Availability of data and material

Data and material are available at claudio.fiorillo@hotmail.it.

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Authors and Affiliations

  1. Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Giuseppe Quero, Claudio Fiorillo, Roberta Menghi, Caterina Cina, Federica Galiandro, Fabio Longo, Francesco Sofo, Fausto Rosa, Antonio Pio Tortorelli & Sergio Alfieri

  2. CRMPG (Advanced Pancreatic Research Center), Largo A. Gemelli, 8, 00168, Rome, Italy

    Giuseppe Quero, Claudio Fiorillo, Roberta Menghi, Caterina Cina, Federica Galiandro, Fabio Longo, Francesco Sofo, Fausto Rosa, Antonio Pio Tortorelli & Sergio Alfieri

  3. Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy

    Giuseppe Quero & Sergio Alfieri

  4. Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy

    Maria Cristina Giustiniani & Frediano Inzani

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  1. Giuseppe Quero
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Contributions

Study conception and design: GQ, SA, CF. Acquisition of data: CC, RM, FG, FS, FI. Analysis and interpretation of data: FL, FR, APT, MCG. Drafting of manuscript: GQ, CF. Critical revision of manuscript: SA, FI, APT.

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Correspondence to Claudio Fiorillo.

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Quero, G., Fiorillo, C., Menghi, R. et al. Total mesopancreas excision for periampullary malignancy: a single-center propensity score-matched comparison of long-term outcomes. Langenbecks Arch Surg 405, 303–312 (2020). https://doi.org/10.1007/s00423-020-01873-4

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