Usefulness of the mesopancreas-first approach using isolating tape in conversion surgery for pancreatic cancer

R0 resection is an important prognostic factor in patients with pancreatic cancer (PC). Advances in chemotherapy have improved the R0 resection rate for unresectable locally advanced (UR-LA) PC. There is a limit to determine on imaging whether R0 resection is possible due to chemotherapy effects. Therefore, we rely on intraoperative frozen section diagnosis (FSD). We devised a mesopancreas-first approach using isolating tape (iTape) to ensure the assessment of resectability before organ dissection. The mesopancreas-first approach using iTape was performed in patients with UR-LA PC who were determined to be able to achieve R0 resection by pancreaticoduodenectomy after chemotherapy. In this method, the mesopancreas is taped before organ dissection, and subsequent mesopancreas separation is performed by pulling the tape. The iTape is first placed through the retroperitoneal space between the mesopancreas and the inferior vena cava followed by extraction from the common hepatic artery, body of the pancreas, and splenic vein on the cranial side of the pancreas and from the superior mesenteric artery on the caudal side of the pancreas. As a result, the iTape is individually enmeshed in the mesopancreas. This way, only the mesopancreas can be dissected, while sparing other organs and tissues. If R0 resection is judged to be difficult by intraoperative FSD, the procedure is converted into bypass surgery. This method may be useful for pancreaticoduodenectomy in conversion cases and the resectability can be evaluated prior to organ dissection. •The space between the pancreas and the IVC was dissected to extract the iTape from lesser sac to the left of the SMA.•The iTape was extracted from the SMA and the dissection line of the cephalic plexus of pancreatic head (PLphII) was exposed.•The iTape was passed through the mesocolon to the cranial side for dissection of the PLphI after PLphII dissection.•The PLphI and II was submitted for intraoperative frozen section analysis.•Organ dissection was performed after intraoperative frozen section analysis confirmed that all nerve plexuses were negative.