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

Risultato della ricerca: Contributo in rivistaArticolo in rivista

1 Citazioni (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.
Lingua originaleEnglish
pagine (da-a)303-312
Numero di pagine10
RivistaLANGENBECK'S ARCHIVES OF SURGERY
Volume405
DOI
Stato di pubblicazionePubblicato - 2020

Keywords

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

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