Global surgeons agree on new pancreatic cancer technique but want proof it works
International cancer experts have reached consensus on how to perform a more aggressive pancreatic surgery called total mesopancreas excision, potentially improving outcomes for thousands of patients annually. However, they emphasize that rigorous clinical trials are urgently needed to demonstrate whether this standardized approach actually saves lives and justifies wider adoption.
Originaltitel: International consensus on mesopancreas and total mesopancreas excision (MESODELPHI).
Kirurgiska standarder för mesopankreasresektion fastslogs nu genom internationell konsensus. En modifierad Delphi-process med 43 experter från 20 länder enades om definition, anatomiska gränser och klinisk tillämpning av total mesopankreasexcision (TMpE) vid pankreascancer. Nittionio procent av deltagarna godkände de anatomiska gränserna för mesopankreas som ett retroperikält vävnadskompartiment innehållande lymfatisk, neurovaskulär och adipös vävnad. 81,4 procent förespråkade TMpE framför konventionell pancreatoduodenektomi vid kurativ kirurgi. Experterna rekommenderade både arterförst- och mesenterialförst-kirurgiska strategier och enades om att ytterligare forskning om TMpEs påverkan på överlevnad är nödvändig. Standarden möjliggör jämförbar forskning, tydliggör leverantörskrav för kirurgisk utbildning och bör vägleda uppdateringar av onkologiska riktlinjer inom regionvården.
BACKGROUND: The absence of a standardized anatomical definition of the mesopancreas has precluded meaningful comparison across studies on total mesopancreas excision (TMpE). The MESODELPHI consensus aimed to establish international agreement on its definition, surgical boundaries, and clinical role in pancreatic cancer management. METHODS: An international modified Delphi process, informed by a prior systematic review, included 43 pancreatic surgery experts from 20 countries across two rounds. Statements were rated on a 5-point Likert scale, with consensus predefined as ≥80% agreement. RESULTS: Consensus was achieved for 19 of 27 statements in Round 1. All participants (100%) agreed the mesopancreas is a retropancreatic compartment of lymphatic, neurovascular, and adipose tissue, with 97.7% agreeing on its anatomical boundaries. Both artery-first and mesenteric-first approaches were considered feasible surgical strategies (97.7%). Most experts (81.4%) favored TMpE over conventional pancreatoduodenectomy for curative-intent surgery. There was strong agreement that further investigation into the impact of TMpE on survival outcomes is necessary (97.7%), and that education on mesopancreas anatomy should be integrated into surgical training programs (93.0%). CONCLUSIONS: This consensus provides the first standardized definition of the mesopancreas, recommends "mesopancreas" as the unifying term over alternative nomenclature, and offers an international framework to guide future research and surgical practice.