Artery First Pancreaticoduodenectomy Versus Conventional Whipple Procedure in Pancreatic Head Adenocarcinoma

Document Type : Original Article

Authors

Department of General Surgery, Gastrointestinal and Liver Surgery Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Abstract

Background: Surgical resection remains the only potentially curative treatment for pancreatic ductal adenocarcinoma,
provided that negative surgical margins (R0) are achieved, in conjunction with appropriate adjuvant therapies. In
particular, the margin adjacent to the superior mesenteric artery has been frequently identified as the most common site
for positive margins (R1) in tumors located in the pancreatic head. Recently, the adoption of the ‘artery-first’ approach
(AFA) during pancreaticoduodenectomy has gained global attention. This technique involves prioritizing the dissection
of the connective tissues surrounding the superior mesenteric artery early in the procedure. The primary goals are to allow
for an early assessment of tumor resectability and to minimize intraoperative blood loss.
Patients and Methods: This The study evaluated two surgical techniques for managing pancreatic head adenocarcinoma: the conventional approach and the artery-first (posterior) approach.
Results: Receiver A total of 32 patients were included, with 15 undergoing the AFA and 17 treated via the conventional
approach. Analysis revealed no statistically significant differences between the two groups in the majority of evaluated
parameters.
Conclusion: The AFA proves to be a valuable surgical technique, particularly in patients with borderline resectable
tumors and those who have undergone neoadjuvant therapy. However, the conventional approach remains a viable option,
with satisfactory outcomes in appropriately selected cases.

Keywords

The Egyptian Journal of Surgery
Volume 44, Issue 2
April 2025
Pages 770-777

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