Comparison of Total Mesopancreatic Excision and Conventional Pancreaticoduodenectomy in the Surgical Treatment of Pancreatic Head Adenocarcinoma: Early Postoperative Outcomes

Egeli T., Unek T., Ozbilgin M., Agalar C., Agalar A., Unek İ. T., ...Daha Fazla

Medicina (Lithuania), cilt.61, sa.10, 2025 (SCI-Expanded, Scopus) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 61 Sayı: 10
  • Basım Tarihi: 2025
  • Doi Numarası: 10.3390/medicina61101725
  • Dergi Adı: Medicina (Lithuania)
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Directory of Open Access Journals
  • Anahtar Kelimeler: pancreatic ductal adenocarcinoma, pancreaticoduodenectomy, total mesopancreatic excision, postoperative complications, treatment outcomes
  • Dokuz Eylül Üniversitesi Adresli: Evet

Özet

Background and Objectives: This study aimed to evaluate and compare the early postoperative outcomes of patients who underwent pancreaticoduodenectomy (PD) with total mesopancreatic excision (TMpE) versus conventional pancreaticoduodenectomy (Co-PD) for pancreatic head ductal adenocarcinoma (PDAC). Materials and Methods: Patients who underwent PD for pancreatic head cancer between January 2021 and December 2024 in our clinic and had a pathological diagnosis of PDAC were included. Patients were stratified into two groups according to the surgical technique performed (TMpE-PD vs. Co-PD). Demographic characteristics and early postoperative clinicopathological data were compared between the groups. Results: A total of 41 patients were included: 17 (41.5%) underwent TMpE-PD and 24 (58.5%) underwent Co-PD. Demographic and clinicopathological parameters were comparable between the groups. Although not statistically significant, the TMpE-PD group demonstrated higher R0 resection rates (58.8% vs. 45.8%; p = 0.412) and greater lymph node yield (33.9 vs. 29.1; p = 0.757) compared to the Co-PD group. Overall postoperative complications were more frequent in the TMpE-PD group (82.4% vs. 63.4%; p = 0.034). A smaller pancreatic duct diameter was associated with an increased risk of postoperative complications in both groups, approaching statistical significance (p = 0.053). Multivariable logistic regression analysis revealed that the surgical technique was not an independent risk factor for postoperative complications (OR: 0.64; 95% CI: 0.14–2.83; p = 0.56). No direct correlation was found between resection margin status (R0 vs. R1) and the development of postoperative complications. Conclusions: TMpE demonstrated non-significant trends toward higher R0 resection rates and greater lymph node yield compared with conventional PD. These findings suggest possible oncological benefits without significantly increasing perioperative morbidity.