The Theoretical Basis And Clinical Application Of Total Mesopancreas Excision For Pancreatic Cancer

Objective:Based on the study of autopsy and related histological examination,understanding the concept of mesopancreas and total mesopancreas excision;Clinical data review for total mesopancreas excision,to evaluate the feasibility and safety of total mesopancreas excision;Through the study of parallel control and conventional pancreaticoduodenectomy,to evaluate total mesopancreas excision is effectiveness in surgery of pancreas head cancer.Methods:(1)Through autopsy,observe the peripancreatic related mesentery,fascia structure,observation of peripancreatic blood vessels and lymphatic vessels,dominant nerve plexus and retroperitoneal structure,understanding mesopancreas and adjacent relationship;and the corresponding body tissue samples for histological examination,surgical anatomy further understanding the basic idea of total mesopancreas excision;(2)The clinical data of 120 cases of pancreatic head cancer undergoing t total mesopancreas excision were retrospectively analyzed.The operative safety and R0 resection rate including pancreaticoduodenectomy with en-bloc resection of total anterior and posterior mesopancreas were evaluated.(3)Compared with conventional pancreaticoduodenectomy group,to evaluate the safety and efficacy of pancreaticoduodenectomy(PD)with en-bloc excision of total anterior and posterior mesopancreas in patients with resectable pancreatic head cancertotal mesopancreas excision group by operation time,intraoperative bleeding,survival time and other indicators of perioperative complication rate,mortality,R0 resection rate.Results:(1)The posterior pancreatic space can be achieved to the left and right sides,and the whole digestive tract is located at the front of the space.The root of the celiac trunk and superior mesenteric artery is the gateway to enter the mesopancreas,while the traditional NO.16 lymph node is the outer structure of mesopancreas.(2)The arterial sheath is an important surgical anatomical structure around the artery,and there is a natural surgical dissection space between the outer membrane of the artery and the sheath of the artery.(3)Pancreaticoduodenectomy(PD)with en-bloc excision of total anterior and posterior mesopancreas can achieve R0 resection.It improves the R0 resection rate of pancreatic head cancer without increasing perioperative morbidity and mortality.(4)Compared with routine pancreaticoduodenectomy,total mesopancreas excision of pancreatic head cancer can significantly improve the rate of R0 resection,reduce the local recurrence rate and improve the overall prognosis.Conclusions:(1)The posterior space of the pancreas is an important anatomical aspect of total mesopancreas resection.The celiac trunk and the superior mesenteric artery are the important anatomical signs of total mesopancreas resection.NO.16 lymph node is an external anatomy structure of the mesopancreas.The strategy of intrathecal dissection has a certain anatomical basis for improving the effect of lymph node dissection.(2)Pancreaticoduodenectomy(PD)with en-bloc excision of total anterior and posterior mesopancreas is safe and feasible,and it can be carried out routinely.(3)Total mesopancreas excision can significantly improve the rate of R0 resection.It is achieved by improving the R0 resection rate of mesopancreas margin,and reducing the postoperative local recurrence rate,and improving the overall prognosis of patients with pancreatic head cancer.