الفهرس 
Total mesopancreatic excision and extended lymphadenectomy in pancreatic head cancer surgery
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Abstract
Purpose: Assessment of mesopancreatic margin and its correlation with tumor size in addition to the role of extended lymphadenectomy in proper staging of the patients. Methods: in 40 Patients undergoing pancreaticoduodenectomy, marking of the mesopancreatic margin for pathological assessment with dissection of perineural plexus and lymph nodes along the coeliac axis, superior mesenteric artery in addition to the standard nodal stations excised which are (stations 5, 6), (stations 12b1, 12b2, and 12c), (stations 17a, 17b, 13a, and 13b), (stations 14a and 14b), and (station 8a). Results: the mesopancreatic margin was positive in 2 patients (5%) and close in 7 patients (17.5%) which denoted that negligence of mesopancratic excision and clearance of the retroperitoneal margin during pancreaticoduodenectomy might have left at least more than 20% of the patients with residual tumor cells after their operation. Addition of paraaortic nodes together with nodal tissues at the mesopancreatic triangle affected the staging of 39% of the patients. Conclusion: mesopancreatic excision is essential in pancreatic head cancers for obtaining a true R0. For proper mesopancreatic excision, all tissues between celiac axis and SMA and PV should be excised together with the standard nodal stations, and this is recently called extended lymphadenectomy which affects patients’ staging yet no proven impact on survival