Management of MESOPANCREAS& TRIANGLE OPERATION.pptx

Management of borderline pancreas malignancy

1. MESOPANCREAS& TRIANGLE OPERATION DR SHAIK SOHAIL MCH SGE RESIDENT SRMC

2. MESOPANCREAS Mesopancreas is a vascularized structure composed of fatty tissue, the nerve plexus and lymph nodes located in pancreatic retroperitoneal region between the pancreas head, superior mesenteric vessels & celiac vessels

3. RADIOLOGICAL EXTENT Borderless structure, extending from posterior surface of the pancreas and the adjacent SMV through the space to the right and left of SMA Down to IVC, the aorto-caval groove, and the aorta. Histologically, a fatty tissue, nerve plexuses and ganglia, blood and lymphatic vessels and lymph nodes. No fibrous capsule or fascia, making it invisible and very difficult to identify during surgery.

4. DEFINITIONS

5. The name was created by analogy to similar structure located around rectum.(mesorectum) Various surgical techniques aimed at precise exploration of this space, primary goal is to apply for a tumor cell free resection margin that provides best outcomes in pancreatic cancer. Thus we have different approaches to SMA and different scopes of excision of surrounding tissues starting from ARTERY FIRST UNCINATE PROCESS FIRST MESOPANCREAS FIRST TRIANGLE OPERATION

6. NFT PLph 1- RT CELIAC GANGLION TO POST SIDE OF PANCREAS HEAD PLph 2- SMA PLEUXES TO LEFT SIDE OF UNCINATE INTESIVE NFT 4 AREAS AROUND SMA AREA A- RT CELIAC GANGLION SUPERIOR PANCREATIC HEAD POST HDL AREA B- SMA AND UNCINATE PROCESS AREAC-SMA AND ANT JEJUNAL MESENTRY AREA D-INF UNCINATE TO POST JEJUNAL MESENTRY

7. JAPANESE CONCEPT

8. TRIANGLE OPERATION

9. DEFINITION THE TRIANGLE OPERATION CONSISTS OF ENBLOC REMOVAL OF MESOPANCREAS FROM TRIANGULAR SPACE DELIMITED BY SMA, CELIAC AXIS, HEPATIC ARTERY, AND PV/SMV AXIS

10. CONCEPT NEOADJUVANT THERAPY FOR BORDERLINE RESECTABLE AND LOCALLY ADVANCED PANCREATIC CANCER HAS BECOME IMPORTANT TREATMENT OPTION RESECTABILITY- 40-60% NOT POSSIBLE TO DIFFERENTIATE BETWEEN VIABLE AND FIBROUS TISSUE BETTER DFS AND OS IN RESECTION PD,DP,OR TP ARTERY FIRST TECHNIQUE EMPLOYED SOFT TISSUE CLEARANCE DONE OVER ADVENTIA AND SKELETONIZATION OF ARTERIES

11. VEIN RESECTION DONE IF NEEDED STABLE DISEASE <30% DECREASE IN TUMOUR DIAMETER

12. THANK YOU