Authors
Luís Felipe Leite, Marcos Belotto, Marcelo Sá de Araújo, Samuel Menezes, Luiz F de Almeida, Mohammad A Hilal, Cándido F Alcázar López, Juan S Azagra, Anita Balakrishnan, Frederik Berrevoet, Marc G Besselink, Gerardo Blanco-Fernández, Ugo Boggi, Oscar Chapa-Azuela, F J F Coimbra, Bobby V M Dasari, Safi Dokmak, Álvaro A Duarte, Massimo Falconi, Alexandre F Oliveira, Giuseppe K Fusai, Isabella Frigerio, Mariano Giménez, Benedetto Ielpo, Yosuke Inoue, Nicolás Jarufe, Enrique J Chavarría, Mickaël Lesurtel, Giuseppe Malleo, Giovanni Marchegiani, Oscar Mazza, Cássio Virgílio C de Oliveira, Nicholas O'Rourke, Sanjay Pandanaboyana, Elena Rangelova, Luis Sabater, Sohei Satoi, Alain Sauvanet, Mario Serradilla-Martín, Ajith K Siriwardena, Ernesto Sparrelid, Patrick Starlinger, Stefan Stättner, Oliver Strobel, Christian Sturesson, Celia Villodre, Jens Werner, Paulo C Galvão do Amaral, Renata D'alpino Peixoto, Pierre-Alain Clavien, José M Ramia
Published in
HPB : the official journal of the International Hepato Pancreato Biliary Association. Jun 30, 2026. Epub Jun 30, 2026.
Abstract
The absence of a standardized anatomical definition of the mesopancreas has precluded meaningful comparison across studies on total mesopancreas excision (TMpE). The MESODELPHI consensus aimed to establish international agreement on its definition, surgical boundaries, and clinical role in pancreatic cancer management.
An international modified Delphi process, informed by a prior systematic review, included 43 pancreatic surgery experts from 20 countries across two rounds. Statements were rated on a 5-point Likert scale, with consensus predefined as ≥80% agreement.
Consensus was achieved for 19 of 27 statements in Round 1. All participants (100%) agreed the mesopancreas is a retropancreatic compartment of lymphatic, neurovascular, and adipose tissue, with 97.7% agreeing on its anatomical boundaries. Both artery-first and mesenteric-first approaches were considered feasible surgical strategies (97.7%). Most experts (81.4%) favored TMpE over conventional pancreatoduodenectomy for curative-intent surgery. There was strong agreement that further investigation into the impact of TMpE on survival outcomes is necessary (97.7%), and that education on mesopancreas anatomy should be integrated into surgical training programs (93.0%).
This consensus provides the first standardized definition of the mesopancreas, recommends "mesopancreas" as the unifying term over alternative nomenclature, and offers an international framework to guide future research and surgical practice.
PMID:
42436071
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.
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