No-Touch Total Mesopancreas Excision for Pancreatic Head Cancer

Pancreatectomy, specifically R0-resection, is the only effective treatment for pancreatic head cancers. The frequent recurrence of cancers within the resection bed may be due to inadequate removal of the so-called mesopancreas margin. Furthermore, surgeons usually grasp tumors during pancreatectomy. However, this practice may increase the risk of cancer cell shedding. In an effort to overcome these problems, we have ameliorated our no-touch pancreatoduodenectomy technique for total mesopancreas excision. The approach allows the tumor to be resected without grasping, and is intended to enable total resection of the mesopancreas. In the current series, 71% of the pancreatoduodenectomy performed for pancreatic ductal adenocarcinoma was R0 resections. Overall and recurrence-free 5-year survival rates after surgery were 42 and 32%, respectively. Those rates of 36 patients after R0 resection were 56 and 39%, respectively. No-touch total mesopancreas excision improved the surgical outcomes except morbidity. This technique may have many theoretic advantages, which merit further investigation in future randomized controlled trials.