Mesopancreas dissection level 3 for pancreatic head cancer in combined robotic/open pancreatoduodenectomy: a propensity score-matched study

Mesopancreas dissection (MPD) level 3 in combined robotic/open pancreatoduodenectomy (CR/OPD) is technique-demanding. This study aims to clarify the feasibility and justification of MPD level 3.

Propensity score matching (PSM) analysis was conducted for 208 patients with pancreatic head cancer undergoing CR/OPD with or without MPD level 3. The comparison focused on surgical and oncological outcomes.

After PSM, each group comprised 86 patients. Surgical outcomes were comparable between these two groups, except longer operation time for MPD level 3 (+), median: 10.5 vs. 9.5 h, p = 0.002. MPD level 3 (+) group exhibited higher lymph node yield, median: 20 vs. 17, p < 0.001, and curative (R0) resection rate, 89.5% vs. 69.8%, p = 0.001, compared to MPD level 3 (−) group. Among the entire cohort, no significant survival difference was observed between the MPD Level 3 (+) and (−) groups. Survival outcome for R0 resection after CR/OPD was notably better than those for R2 resection, 5-year survival: 34.0% vs. 0, p = 0.038. However, within the curative (R0) resection cohort, no survival difference was observed between the MPD level 3 (+) and MPD level 3 (−) groups.

MPD level 3 in CR/OPD is technically feasible without increasing the surgical risks but takes one hour extra operating time. Incorporation of MPD level 3 does not confer a survival advantage within the curative (R0) resection cohort. The primary focus should continue to be on achieving curative (R0) resection to maximize the survival benefits for pancreatic head cancer.