Morphological and histopathological characteristics of the mesopancreas in patients with pancreatic head ductal adenocarcinoma

Abstract

The mesopancreas is frequently involved in pancreatic ductal adenocarcinoma of the pancreatic head. Although it lacks a clearly defined anatomical boundary, it is closely associated with postoperative local recurrence and plays an important role in achieving R0 resection. This descriptive study included 68 patients diagnosed with pancreatic ductal adenocarcinoma who underwent pancreaticoduodenectomy at Bach Mai Hospital between January 2023 and June 2025. The results showed that the mesopancreas had a quadrangular configuration, with mean side lengths of 4.79 × 5.11 × 2.66 × 2.18 cm and a mean thickness ranging from 0.48 to 0.68 cm. Mesopancreatic invasion was identified in more than half of the patients with pancreatic head ductal adenocarcinoma (57.35%). It was significantly associated with lymphatic invasion (p=0.001) and regional lymph node metastasis (p=0.047), whereas no significant association was observed with tumor size, perineural invasion, venous invasion, or histological grade. These findings support the concept of the mesopancreas as a “centre of local spread” in pancreatic ductal adenocarcinoma through the lymphatic-nodal pathway, while also highlighting the importance of detailed assessment and reporting of mesopancreatic features in clinical practice. Such evaluation may help surgeons refine operative techniques and improve the likelihood of radical resection.