Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2022; 14(7): 720-722
Published online Jul 27, 2022. doi: 10.4240/wjgs.v14.i7.720
Total mesopancreas excision is the better staging tool of the mesopancreas in pancreatic head carcinoma
Nadia Peparini
Nadia Peparini, Azienda Sanitaria Locale Roma 6, Distretto 3, Rome 00043, Italy
Author contributions: Peparini N conceived, drafted and critically revised the manuscript and gave the final approval.
Conflict-of-interest statement: No conflict of interest exists.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nadia Peparini, MD, PhD, Doctor, Azienda Sanitaria Locale Roma 6, Distretto 3, via Mario Calò 5,Rome 00043, Italy.nadiapeparini@yahoo.it
Received: December 9, 2021
Peer-review started: December 9, 2021
First decision: April 19, 2022
Revised: April 25, 2022
Accepted: June 20, 2022
Article in press: June 20, 2022
Published online: July 27, 2022
Processing time: 229 Days and 15.3 Hours
Abstract

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.

Keywords: Pancreatic head carcinoma; Mesopancreas; Total mesopancreas excision; Staging; Preoperative imaging; Surgery

Core Tip: To date, among all therapeutic tools, 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.