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What do surgeons need to know about the mesopancreas

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Abstract

Background

Pancreatoduodenectomy is the only treatment with a promise of cure for patients with pancreatic head adenocarcinoma, and a negative resection margin is an important factor related to overall survival. Complete clearance of the medial margin with removal of the so-called mesopancreas may decrease the recurrence rate after pancreatic resection. Here, we present some important information about the mesopancreas, total mesopancreas excision, and technical aspects to achieve negative resection margins. The area named mesopancreas is defined as the tissue located between the head of the pancreas and the superior mesenteric vessels and the celiac axis and consists of the nerve plexus, lymphatic tissue, and connective tissue. The superior mesenteric and celiac arteries define the border of the mesopancreas. En bloc resection of anterior and posterior pancreatoduodenal nodes, hepatoduodenal nodes, along the superior mesenteric artery nodes, pyloric nodes, and nodes along the common hepatic artery is necessary.

Conclusions

Improved knowledge of the surgical anatomy of the region and technical refinements of excision of the mesopancreas along with standardized pathological examination are important to increase and to determine radical resection of pancreatic head cancer.

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Authors and Affiliations

  1. Department of Surgery, Adventista Silvestre Hospital, Rio de Janeiro, RJ, Brazil

    Eduardo de Souza M. Fernandes & Camila Girão

  2. Department of Surgery, São Lucas Hospital-Rede Dasa, Rio de Janeiro, RJ, Brazil

    Eduardo de Souza M. Fernandes & Camila Girão

  3. Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany

    Oliver Strobel

  4. Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria

    Oliver Strobel

  5. Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Presidente Dutra Hospital, São Luiz, Brazil

    Jose Maria A. Moraes-Junior & Orlando Jorge M. Torres

  6. Department of Hepatopancreatobiliary Surgery, Hospital São Domingos-Rede Dasa, São Luiz, Brazil

    Jose Maria A. Moraes-Junior & Orlando Jorge M. Torres

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  1. Eduardo de Souza M. Fernandes
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  2. Oliver Strobel
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  5. Orlando Jorge M. Torres
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Correspondence to Orlando Jorge M. Torres.

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Fernandes, E.d.M., Strobel, O., Girão, C. et al. What do surgeons need to know about the mesopancreas. Langenbecks Arch Surg 406, 2621–2632 (2021). https://doi.org/10.1007/s00423-021-02211-y

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