‘Artery-first’ approaches to pancreatoduodenectomy

Abstract

There are several conceptual approaches to performing the mobilization stage in pancreatoduodenal resection (PDR). The ‘artery-first’ approach allows definitive staging of the tumor process in patients with suspected involvement of the superior mesenteric vessels before transection of the isthmus of the pancreas. Material and methods. In 2006–2020, 73 PDRs were performed, the traditional method of mobilization was used in 57 patients, according to the principle ‘artery-first’ in 16 patients. After neoadjuvant chemotherapy, 10 patients were operated on; the use of the “from the arteries” approach made it possible to abandon the attempt of radical resection in 3 patients. Results. The duration of the operation with the traditional approach and with mobilization ‘аrteryfirst’ was 5.18 vs 7.2 hours (p=0.0002). Blood loss did not differ (500 vs 550 ml respectively). Postoperative complications, which required active treatment and influenced the duration of hospitalization, were noted in 12.5% of patients; there were no differences in them in the groups. The R0-rate of resections for pancreatic head cancer was 84.8 and 93.75% respectively (p=0.65). With traditional PDD, mortality was 5.2%, with mobilization ‘artery-first’ there were no lethal outcomes (p=1.0). Conclusion. The use of the mobilization technique ‘artery-first’ does not lead to an increase in the number of postoperative complications and mortality, but it allows the final staging of the tumor to the point of no return and increase the radicalism of the PDR.