THE MESOPANCREAS REMAINS AT RISK IN PRIMARY RESECTABLE PANCREATIC CANCER PATIENTS: TIME TO REAPPRAISE RESECTABILITY CRITERIA? StephanOliver.David@med.uni-duesseldorf.de

 

THE MESOPANCREAS REMAINS AT RISK IN PRIMARY RESECTABLE PANCREATIC CANCER PATIENTS: TIME TO REAPPRAISE RESECTABILITY CRITERIA?

5

Germany

Poster with Discussion

Pancreatic ductal adenocarcinoma remains one of the most aggressive malignancies, characterized by late diagnosis, complex local anatomy, and poor overall survival. To improve resection outcomes, pretherapeutic stratification models and international classification systems categorize PDACs based on the vascular involvement around the medial vascular groove, considering tumor contact with arterial and portomesenteric venous structures. However, these criteria are anatomically unidimensional. The dorsal resection margin, which incorporates the mesopancreas is evenly as risk for a R1 resection. Increasing evidence underlines the oncological relevance of the mesopancreas (MP). Recent studies have highlighted the oncological relevance of mesopancreatic excision (MPE), demonstrating superior local control. However, it remains unclear whether mesopancreatic infiltration occurs in primarily resectable PDAC patients and how it affects surgical outcomes. This study investigates MP involvement in a consecutive, non-selected PDAC cohort, integrating current radiological and histopathological standards to evaluate the impact of the mesopancreas on resection margin status.

Radiographic and histopathological staging parameters of the 271 PDAC Patients were evaluated according to the current NCCN resectability criteria. Subsequently the resectates were examined for carcinomatous mesopancreatic infiltration

In 271 PDAC patients, mesopancreatic involvement was present in 76.9% and significantly correlated with incomplete resection (p=0.004) in primary-resectable patients. Standardized resectability classifications, failed to correlate and predict MP infiltration status and margin status.

Our study demonstrates that mesopancreatic involvement significantly increases the risk of incomplete resection, particularly in patients classified as primarily resectable. These findings support the inclusion of the mesopancreas in resectability criteria to enhance surgical planning and treatment outcomes.