-Original-

Treatment of Advanced Pancreatic Body and Tail Cancer by En Bloc Distal Pancreatectomy with Transverse Mesocolon Resection Using a Mesenteric Approach

Satoshi Mizutani¹, Nobuhiko Taniai¹, Hiroyasu Furuki¹, Mio Shioda¹, Junji Ueda¹, Takayuki Aimoto¹, Norio Motoda², Yoshiharu Nakamura³ and Hiroshi Yoshida³

¹Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
²Department of Pathology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
³Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, Japan

Background: Pancreatic body and tail cancer easily invades retroperitoneal tissue, including the transverse mesocolon. It is difficult to ensure a dissected peripancreatic margin with standard distal pancreatectomy for advanced pancreatic body and tail cancer. Thus, we developed a novel surgical procedure to ensure dissection of the peripancreatic margin. This involved performing dissection deeper than the fusion fascia of Toldt and further extensive en bloc resection of the root of the transverse mesocolon. We performed distal pancreatectomy with transverse mesocolon resection (DP-TCR) using a mesenteric approach and achieved good outcomes.
Methods: There are two main considerations for surgical procedures using a mesenteric approach: 1) dissection deeper than the fusion fascia of Toldt (securing the vertical margin) and 2) modular resection of the pancreatic body and tail, with the root of the transverse mesocolon and adjacent organs in a horizontal direction (ensuring the caudal margin).
Results: From 2017 to 2019, we performed DP-TCR using a mesenteric approach for six patients with advanced pancreatic body and tail cancer. Histopathological radical surgery was possible in all patients who underwent DP-TCR. No Clavien-Dindo grade IIIa or worse perioperative complications were observed in any patient.
Conclusions: We believe that DP-TCR is useful as a radical surgery for advanced pancreatic body and tail cancer with extrapancreatic invasion.

J Nippon Med Sch 2021; 88: 301-310

Keywords
distal pancreatectomy, mesenteric approach, pancreatic body and tail cancer

Correspondence to
Dr. Satoshi Mizutani, Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
mizutani@nms.ac.jp

Received, May 7, 2020
Accepted, July 31, 2020