Artery first versus traditional approach in pancreatoduodenectomy for pancreatic head cancer

Background: Artery first approach pancreatoduodenectomy (AFAPD) technique is one of the many modifications of the standard whipple procedure (sPD) thus enabling a complete dissection of the right side of this artery and of the portal vein, as well as a complete excision of the retroportal pancreatic lamina. Objective was to evaluate the clinical, perioperative and oncological outcomes of “artery first” approach compared with those of the traditional approach.Methods: Between 2010 and 2019, The present study includes two groups of patients. A first group of 28 patients with PD by “artery first” and a second group including 28 matched patients with PD by TAPD. Demographic characteristics (sex, age), intraoperative data (approach type, operative time, blood loss, intraoperative complications, need for vascular resections), histological diagnosis and pathology data (tumor location, TNM staging, tumor grading, tumor vascular invasion) and patient outcomes (postoperative length of stay, in-hospital postoperative mortality and morbidity, survival time) were collected.Results: There were no significant differences between the two groups regarding: total operative time (422 vs. 460.min, p=0.19), estimated blood loss (p=0.67), median length of stay (14 days in both groups) (p=0. 0.39), complication rates (32.1% and 35.7%) (p=0. 1.00), lymph node yield (22 and 21) and R0 resection rate (75% and 67.9%). Conclusions: We concluded that artery first” offers similar operative time, intraoperative blood loss, R0 resection rates, lymph node yield and long-term survival as TAPD.