Total mesopancreas excision is the better staging tool of the mesopancreas in pancreatic head carcinoma

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.