Mesopancreas is a misnomer: time to correct the nomenclature

Abstract

Focused pathological attention to tumor invasion of the retroperitoneal resection margin after pancreaticoduodenectomy for cancer of head of the pancreas led to the knowledge of strong tendency of cancer cells to infiltrate into the retropancreatic tissue and to spread along the peripancreatic neural plexuses as the cause of local recurrence. The term 'mesopancreas' was coined to describe perineural lymphatic layer located dorsally to the pancreas and it was suggested that its complete resection will minimize loco-regional recurrence and improve outcome. This catchy title and concept attracted the attention of surgeons and "total meso-pancreas excision" was introduced by 'artery first' or 'posterior first' surgical techniques to ensure 'en-bloc' extended resection of retropancreatic lymphatics. However, mesopancreas is a misnomer and cannot be called a 'true' mesentery as it does not have a fascial envelope attaching the pancreas to the posterior wall of the abdomen and does not contain 'all' its blood vessels and 'all' its primary draining lymphatics and lymph nodes. Japan Pancreas Society's description of pancreatic head plexus II is anatomically consistent with 'mesopancreas' and it should be renamed as such. This nomenclature clearly illustrates its exact anatomical location and surgical relevance; and stands up to necessary rigorous scientific scrutiny.

Keywords: Carcinoma head of pancreas; Mesopancreas; Pancreaticoduodenectomy.