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

Fausto Rosa, Sergio Alfieri, Giuseppe Quero, Claudio Fiorillo, Roberta Menghi, Antonio Pio Tortorelli, Maria Cristina Giustiniani, Frediano Inzani, Caterina Cina, Federica Galiandro, Fabio Longo, Francesco Sofo

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)303-312
Number of pages10
JournalLANGENBECK'S ARCHIVES OF SURGERY
Volume405
DOIs
Publication statusPublished - 2020

Keywords

  • Long-term outcomes
  • Periampullary malignancy
  • Pancreaticoduodenectomy
  • Mesopancreas

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