{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T21:57:23Z","timestamp":1784239043938,"version":"3.55.0"},"reference-count":44,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy Carol Davila"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: The concept of mesopancreas is frequently discussed in the surgical literature as the neural pathway for metastatic spread in pancreatic head cancer. It generally refers to a retro-pancreatic plane that should be resected to reduce the incidence of regional metastases. However, this concept remains poorly defined, both embryologically and anatomically. Our objective was to establish a clear embryological and anatomical definition of the mesopancreas, making anatomical data more applicable in surgical practice. Methods: We examined seven cadavers (5 males, 2 females, aged 62\u201371) with no medical or surgical history, preserved in 9% formalin at Carol Davila University\u2019s Anatomy Department. Regional dissections were performed in successive planes, highlighting the celiac ganglia and the associated network of neural connections that comprise the mesopancreas. Results: Our study defines the \u201cmesopancreas\u201d as remnants of primordial mesenteries that coalesced into the Treitz fascia. We identified its functional components as nerve fibers linking the celiac ganglia and superior mesenteric plexus to the pancreas, along with vascular structures, lymphatics, and connective and adipose tissue. These components likely contribute to regional metastasis in pancreatic head cancer. While resection of the mesopancreas could help prevent metastasis, its complex anatomy and proximity to major vessels pose significant surgical challenges. Conclusions: Based on our findings, we propose a plausible definition for the term \u201cmesopancreas\u201d. It encompasses the structures that originated as part of the primordial mesenteries, which subsequently coalesced, resulting in the formation of the Treitz fascia. In essence, the mesopancreas is the functional content of a former mesentery.<\/jats:p>","DOI":"10.3390\/diagnostics15070914","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T16:26:31Z","timestamp":1743611191000},"page":"914","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Mesopancreas\u2014Anatomical Insights and Its Implications for Diagnosis and Clinical and Surgical Practice"],"prefix":"10.3390","volume":"15","author":[{"given":"Florin-Mihail","family":"Filipoiu","sequence":"first","affiliation":[{"name":"Discipline of Anatomy, Department 2\u2013Morphological Sciences, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1225-097X","authenticated-orcid":false,"given":"Georgian-Theodor","family":"Badea","sequence":"additional","affiliation":[{"name":"Discipline of Anatomy, Department 2\u2013Morphological Sciences, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Doctoral School, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaly","family":"Enyedi","sequence":"additional","affiliation":[{"name":"Discipline of Anatomy, Department 2\u2013Morphological Sciences, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0218tefan","family":"Oprea","sequence":"additional","affiliation":[{"name":"Discipline of Anatomy, Department 2\u2013Morphological Sciences, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoran-Florin","family":"Filipoiu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8603-5807","authenticated-orcid":false,"given":"Daniela-Elena Gheoca","family":"Mutu","sequence":"additional","affiliation":[{"name":"Discipline of Anatomy, Department 2\u2013Morphological Sciences, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1186\/s12957-024-03495-2","article-title":"Radicality and safety of total mesopancreatic excision in pancreatoduodenectomy: A systematic review and meta-analysis","volume":"22","author":"Belotto","year":"2024","journal-title":"World J. Surg. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"389","DOI":"10.14701\/ahbps.2020.24.4.389","article-title":"En bloc proximal peri-mesenteric clearance for pancreatic head cancer surgery","volume":"24","author":"Kang","year":"2020","journal-title":"Ann. Hepato-Biliary-Pancreat. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/1477-7819-5-44","article-title":"Resection of the mesopancreas (RMP): A new surgical classification of a known anatomical space","volume":"5","author":"Gockel","year":"2007","journal-title":"World J. Surg. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1097\/00000658-200112000-00007","article-title":"Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and\/or chemotherapy in the ESPAC-1 randomized controlled trial","volume":"234","author":"Neoptolemos","year":"2001","journal-title":"Ann. Surg."},{"key":"ref_5","first-page":"237","article-title":"The retroperitoneal resection margin and vessel involvement are important factors determining survival after pancreaticoduodenectomy for ductal adenocarcinoma of the head of the pancreas","volume":"433","author":"Vogel","year":"1988","journal-title":"Virchows Arch."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2899","DOI":"10.1007\/s00423-021-02368-6","article-title":"Mesopancreas\u2014New unknown land or a mirage?","volume":"Volume 406","author":"Olakowski","year":"2021","journal-title":"Langenbeck\u2019s Archives of Surgery"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.amjsurg.2017.05.007","article-title":"Has survival improved following resection for pancreatic adenocarcinoma?","volume":"214","author":"Luberice","year":"2017","journal-title":"Am. J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Popescu, I., and Dumitrascu, T. (2018). What Is the Value of Total Mesopancreas Excision in Pancreatic Ductal Adenocarcinoma? Current Evidence of the Literature, Editura Celsius.","DOI":"10.21614\/chirurgia.113.3.335"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.ejso.2011.12.015","article-title":"Surgical technique and results of total mesopancreas excision (TMpE) in pancreatic tumors","volume":"38","author":"Adham","year":"2012","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"DeRoss, A.L. (2012). Surgical Diseases of the Stomach and Duodenum in Infants and Children. Shackelford\u2019s Surgery of the Alimentary Tract Volume 1-2, Elsevier. [7th ed.].","DOI":"10.1016\/B978-1-4377-2206-2.00066-X"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1007\/s00276-011-0800-3","article-title":"Moving and fusion of the pancreatic buds in the rat embryos during the embryonic period (carnegie stages 13-17) bya three-dimensional computer-assisted reconstruction","volume":"33","author":"Godlewski","year":"2011","journal-title":"Surg. Radiol. Anat."},{"key":"ref_12","unstructured":"(2022, October 12). PARLAMENTUL ROMANIEI, \u201cLEGE nr. 104 din 27 Martie 2003 (*Republicat\u0103*) Privind Manipularea Cadavrelor Umane \u0219i Prelevarea Organelor \u0219i \u021aesuturilor de la Cadavre \u00een Vederea Transplantului\u201d. Available online: https:\/\/legislatie.just.ro\/public\/DetaliiDocument\/42803."},{"key":"ref_13","unstructured":"Waasdorp Hurtado, C., Christine Waasdorp, F., Reviewers Sferra, T., and Polk, B. (2022, October 12). Naspghan Physiology Lecture Series Embryology and Anatomy of the Gastrointestinal Tract. Available online: http:\/\/www.ajronline.org."},{"key":"ref_14","unstructured":"Cochard, L.R. (2012). Netter\u2019s Atlas of Human Embryology, Elsevier."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1007\/s00534-009-0126-2","article-title":"An investigation of the embryologic development of the fascia used as the basis for pancreaticoduodenal mobilization","volume":"16","author":"Cho","year":"2009","journal-title":"J. Hepato-Biliary-Pancreat. Surg."},{"key":"ref_16","unstructured":"Donovan, M.F., and Cascella, M. (2022, October 10). Embryology, Weeks 6-8. StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/sites\/books\/NBK563181\/."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.ijsu.2018.01.041","article-title":"The outcomes and complications of pancreaticoduodenectomy (Whipple procedure): Cross sectional study","volume":"52","author":"Karim","year":"2018","journal-title":"Int. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"705","DOI":"10.26574\/maedica.2023.18.4.705","article-title":"Outcomes and Complications of Duodenopancreatectomy in Octogenarian Patients: A Review","volume":"18","author":"Coco","year":"2023","journal-title":"Maedica"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7043","DOI":"10.1245\/s10434-024-15764-1","article-title":"Robotic Versus Laparoscopic Pancreaticoduodenectomy for Pancreatic Cancer: Evaluation and Analysis of Surgical Efficacy","volume":"31","author":"Dai","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Feng, Q., Jiang, C., Feng, X., Du, Y., Liao, W., Jin, H., Liao, M., Zeng, Y., and Huang, J. (2021). Robotic Versus Laparoscopic Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.752236"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1002\/ca.22461","article-title":"The surgical anatomy of the lymphatic system of the pancreas","volume":"28","author":"Cesmebasi","year":"2015","journal-title":"Clin. Anat."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.canlet.2015.11.048","article-title":"The Lymphatic System and Pancreatic Cancer","volume":"381","author":"Fink","year":"2015","journal-title":"Cancer Lett."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/j.ejso.2007.02.037","article-title":"Technical limitations of lymph node mapping in pancreatic cancer","volume":"33","author":"Kocher","year":"2007","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_24","first-page":"206","article-title":"Sentinel lymph node mapping in tumors of the pancreatic body: Preliminary report","volume":"16","author":"Hogendorf","year":"2012","journal-title":"Contemp. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1002\/bjs.11115","article-title":"Impact of resection margin status on recurrence and survival in pancreatic cancer surgery","volume":"106","author":"Tummers","year":"2019","journal-title":"Br. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.1007\/s00423-021-02211-y","article-title":"What do surgeons need to know about the mesopancreas","volume":"Volume 406","author":"Fernandes","year":"2021","journal-title":"Langenbeck\u2019s Archives of Surgery"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/0140-6736(93)90207-W","article-title":"Mesorectal excision for rectal cancer","volume":"341","author":"MacFarlane","year":"1993","journal-title":"Lancet"},{"key":"ref_28","first-page":"130","article-title":"Total mesorectal excision: Technical aspects","volume":"47","author":"Phang","year":"2004","journal-title":"Can. J. Surg."},{"key":"ref_29","first-page":"202","article-title":"Total meso-pancreas excision: Key point of resection in pancreatic head adenocarcinoma","volume":"58","author":"Popescu","year":"2011","journal-title":"Hepatogastroenterology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1007\/s12094-018-1869-5","article-title":"Systematic review of the mesopancreas: Concept and clinical implications","volume":"20","author":"Ramia","year":"2018","journal-title":"Clin. Transl. Oncol."},{"key":"ref_31","first-page":"4","article-title":"Early ligation of the inferior pancreaticoduodenal artery to reduce blood loss during pancreaticoduodenectomy","volume":"51","author":"Ohigashi","year":"2004","journal-title":"Hepatogastroenterology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1007\/s00464-015-4359-7","article-title":"Laparoscopic pancreatoduodenectomy with superior mesenteric artery-first approach and pancreatogastrostomy assisted by mini-laparotomy","volume":"30","author":"Zimmitti","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Lee, J.M., and Yoon, J.H. (2017). Imaging Diagnosis of Pancreatic Cancer: CT and MRI. Pancreatic Cancer: With Special Focus on Topical Issues and Surgical Techniques, Springer Nature.","DOI":"10.1007\/978-3-662-47181-4_7"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.rcl.2012.03.008","article-title":"Imaging of Pancreatic Adenocarcinoma: Update on Staging\/Resectability","volume":"50","author":"Tamm","year":"2012","journal-title":"Radiol. Clin."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1097\/PPO.0b013e318274a461","article-title":"Multimodality imaging of pancreatic cancer-computed tomography, magnetic resonance imaging, and positron emission tomography","volume":"18","author":"Raman","year":"2012","journal-title":"Cancer J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1148\/rg.324115143","article-title":"State-of-the-art PET\/CT of the pancreas: Current role and emerging indications","volume":"32","author":"Sahani","year":"2012","journal-title":"Radiographics"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Puranik, A.D., Agrawal, A., Shah, S., Purandare, N., and Rangarajan, V. (2018). PET\/CT in Pancreatic Malignancies. PET\/CT in Hepatobiliary and Pancreatic Malignancies, Springer International Publishing.","DOI":"10.1007\/978-3-319-60507-4_7"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.nic.2008.01.001","article-title":"Perineural Tumor Spread","volume":"18","author":"Maroldi","year":"2008","journal-title":"Neuroimaging Clin. N. Am."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Bilreiro, C., and Matos, C. (2021). Diffusion-Weighted Imaging of the Pancreas. Diffusion Weighted Imaging of the Hepatobiliary System: Techniques and Clinical Applications, Springer International Publishing.","DOI":"10.1007\/978-3-319-62977-3_6"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12967-016-0920-y","article-title":"Diffusion-weighted and dynamic contrast-enhanced MRI of pancreatic adenocarcinoma xenografts: Associations with tumor differentiation and collagen content","volume":"14","author":"Wegner","year":"2016","journal-title":"J. Transl. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1916","DOI":"10.1245\/s10434-023-14686-8","article-title":"Levels of Robotic Mesopancreas Dissection According to Malignancy and Vascular Anatomy: What Surgeons Need to Know","volume":"31","author":"Ielpo","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"6169","DOI":"10.1007\/s00464-024-11219-6","article-title":"Development of the multiple scope transition method in robotic pancreaticoduodenectomy","volume":"38","author":"Kitano","year":"2024","journal-title":"Surg. Endosc."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Helton, W.S., and Rose, J.B. (2014). Intraoperative and Laparoscopic Ultrasound During Pancreatic Surgery. Abdominal Ultrasound for Surgeons, Springer International Publishing.","DOI":"10.1007\/978-1-4614-9599-4_12"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"5678","DOI":"10.1007\/s00464-024-11147-5","article-title":"Comparing oncologic and surgical outcomes of robotic and laparoscopic distal pancreatectomy: A propensity-matched analysis","volume":"38","author":"Chang","year":"2024","journal-title":"Surg. Endosc."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/7\/914\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:08:30Z","timestamp":1760029710000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/7\/914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,2]]},"references-count":44,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["diagnostics15070914"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15070914","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,2]]}}}